Federal Register / Vol. 85, No. 232 / Wednesday, December 2, 2020 / Notices 77487 

information collection request at 

www.reginfo.gov. 

SUPPLEMENTARY INFORMATION: 

Title: Request for Transfer of Property 

Seized/Forfeited by a Treasury 

Forfeiture Fund Participating Agency. 

OMB Control Number: 1505–0152. 

Type of Review: Revision of a 

currently approved request. 

Description: This form is an 

application from local law enforcement 

entities to the Treasury Department to 

request a percentage of proceeds or 

tangible property that has been seized/ 

forfeited by the federal government. 

Form: TD F 92–22.46. 

Affected Public: Federal, state and 

local law enforcement agencies 

participating in the Department of the 

Treasury Asset Sharing Program. 

Estimated Number of Respondents: 

7,000. 

Frequency of Response: On Occasion. 

Estimated Total Number of Annual 

Responses: 7,000. 

Estimated Time per Response: 30 

Minutes. 

Estimated Total Annual Burden 

Hours: 3,500. 

Request for Comments: Comments 

submitted in response to this notice will 

be summarized and included in the 

request for Office of Management and 

Budget approval. All comments will 

become a matter of public record. 

Comments are invited on: (a) Whether 

the collection of information is 

necessary for the proper performance of 

the functions of the agency, including 

whether the information shall have 

practical utility; (b) the accuracy of the 

agency’s estimate of the burden of the 

collection of information; (c) ways to 

enhance the quality, utility, and clarity 

of the information to be collected; (d) 

ways to minimize the burden of the 

collection of information on 

respondents, including through the use 

of technology; and (e) estimates of 

capital or start-up costs and costs of 

operation, maintenance, and purchase 

of services required to provide 

information. 

Authority: 44 U.S.C. 3501 et seq. 

Dated: November 27, 2020. 

Spencer W. Clark, 

Treasury PRA Clearance Officer. 

[FR Doc. 2020–26583 Filed 12–1–20; 8:45 am] 

BILLING CODE 4810–25–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0823] 

Agency Information Collection Activity 

Under OMB Review: Expanded Access 

to Non-VA Care Through the MISSION 

Act: Veterans Community Care 

Program 

AGENCY: Veterans Health 

Administration, Department of Veterans 

Affairs. 

ACTION: Notice. 

SUMMARY: In compliance with the 

Paperwork Reduction Act (PRA) of 

1995, this notice announces that the 

Veterans Health Administration, 

Department of Veterans Affairs, will 

submit the collection of information 

abstracted below to the Office of 

Management and Budget (OMB) for 

review and comment. The PRA 

submission describes the nature of the 

information collection and its expected 

cost and burden, and it includes the 

actual data collection instrument. 

DATES: Written comments and 

recommendations for the proposed 

information collection should be sent 

within 30 days of publication of this 

notice to www.reginfo.gov/public/do/ 

PRAMain. Find this particular 

information collection by selecting 

‘‘Currently under 30-day Review—Open 

for Public Comments’’ or by using the 

search function. Refer to ‘‘OMB Control 

No. 2900–0823.’’ 

FOR FURTHER INFORMATION CONTACT: 

Danny S. Green, Office of Quality, 

Performance and Risk (OQPR), 

Department of Veterans Affairs, 810 

Vermont Avenue NW, Washington, DC 

20420, (202) 421–1354 or email 

danny.green2@va.gov Please refer to 

‘‘OMB Control No. 2900–0823’’ in any 

correspondence. 

SUPPLEMENTARY INFORMATION: 

Authority: 44 U.S.C. 3501–21. 

Title: Expanded Access to Non-VA 

Care through the MISSION Act: 

Veterans Community Care Program (VA 

Forms 10–10143, 10–10143a, 10– 

10143b, 10–10143c, 10–10143e, 10– 

10143f and 10–10143g). 

OMB Control Number: 2900–0823. 

Type of Review: Revision and 

extension of a currently approved 

collection. 

Abstract: Section 101 of the VA 

Maintaining Internal Systems and 

Strengthening Integrated Outside 

Networks (MISSION) Act of 2018 

requires VA to implement the Veterans 

Community Care Program to furnish 

care in the community to covered 

Veterans through eligible entities and 

providers, under circumstances as 

further prescribed in the MISSION Act. 

VA currently collects information that 

will be required to implement the 

Veterans Community Care Program 

(VCCP) under the Veterans Choice 

Program, through an OMB approved 

collection 2900–0823. 

OMB Collection 2900–0823 now 

includes VA Form 10–10143, Election to 

Receive Authorized Non-VA Care and 

Selection of Provider for the Veterans 

Community Care Program; VA Form 10– 

10143a, Veterans Community Care 

Health Insurance Certification; VA Form 

10–10143b, Submission of Medical 

Record Information under the Veterans 

Community Care Program; VA Form 10– 

10143c, Submission of Information on 

Credentials and Licenses by Eligible 

Entities and Providers; and VA Form 

10–10143e, Secondary Authorization 

Request for VA Community Care. In 

addition, two new forms that received 

emergency PRA clearances from OMB in 

2020 are included in 2900–0823: VA 

Form 10–10143f, Community Care 

Document Cover Sheet; and VA Form 

10–10143g, Non-VA Hospital 

Emergency Notification. 

VA seeks to update OMB collection 

2900–0823 to implement the Veterans 

Community Care Program by updating 

the title of VA forms and any associated 

statutory citations to be consistent with 

the new program and the MISSION Act, 

by adding a new cover sheet to use 

when submitting documentation from 

providers of non-VA emergent care, by 

adding a new 72-hour notification form 

to be used when a Veteran receives 

emergent care from a non-VA provider, 

and by updating burden hours to 

account for estimated increased use of 

community care under the new 

program. 

This collection of information is 

required to properly adjudicate and 

implement the requirements of the 

MISSION Act. 

a. VA Form 10–10143 will collect 

Veteran information on whether covered 

Veterans would elect to receive 

authorized care under the Veterans 

Community Care Program (VCCP) if 

certain conditions are met, as required 

by 38 U.S.C. 1703(d)(3). This form also 

will allow a covered Veteran to specify 

a particular non-VA entity or provider. 

b. VA Form 10–10143a will collect 

other health insurance information from 

covered Veterans who elect to 

participate in the VCCP, as required by 

38 U.S.C. 1705A. This information also 

is required by 38 U.S.C. 1703(j), which 

requires VA to recover or collect 

reasonable charges for community care 

that is furnished from a health care plan 

contract described in 38 U.S.C. 1729. 

77488 Federal Register / Vol. 85, No. 232 / Wednesday, December 2, 2020 / Notices 

c. VA Form 10–10143b will collect 

health records of covered Veterans from 

non-VA health care entities and 

providers for care authorized under the 

VCCP, as required by 38 U.S.C. 

1703(a)(2)(A), which requires VA to 

establish a mechanism to receive 

medical records from non-VA providers. 

A copy of all medical and dental records 

(including but not limited to images, 

test results, and notes or other records 

of what care was provided and why) 

related to a Veteran’s care provided 

under the VCCP must be submitted to 

VA, including any claims for payment 

for the furnishing of such care. 

d. VA Form 10–10143c will collect 

information from non-VA entities and 

providers concerning relevant 

credentials and licenses as required for 

such entities or providers to furnish care 

and services generally. This information 

is authorized by section 133 of the 

MISSION Act, which requires VA to 

establish competency standards for nonVA providers, as well as 38 U.S.C. 

1703C(a)(1), which requires VA to 

establish certain standards of quality for 

furnishing care and services (including 

through non-VA providers). 

e. VA Form 10–10143e will collect 

secondary authorization requests from 

non-VA entities and providers to 

furnish care and services in addition to 

or supporting the original authorization 

for care. This information is required by 

38 U.S.C. 1703(a)(3), which establishes 

that a covered Veteran may only receive 

care or services under the VCCP upon 

VA’s authorization of such care or 

services. 

f. VA Form 10–10143f will allow for 

the submission of paper documents in 

support of a non-VA provider claim for 

emergency care rendered in the 

community when not accompanied by a 

paper Health Care Claim form. This 

Community Care Document Cover Sheet 

will be used exclusively for the 

submission of medical documentation 

for unauthorized emergent services for 

patients otherwise covered by VA. 

g. VA Form 10–10143g will be used 

to provide 72-hour notification to VA 

when a Veteran receives emergent care 

from a non-VA provider. This form 

should be completed by the non-VA 

provider within 72 hours of the 

beginning of treatment. 

An agency may not conduct or 

sponsor, and a person is not required to 

respond to, a collection of information 

unless it displays a currently valid OMB 

control number. The Federal Register 

Notice with a 60-day comment period 

soliciting comments on this collection 

of information was published at 85 FR 

158 on August 14, 2020, pages 49720 

and 49721. 

VA Form 10–10143 

Affected Public: Individuals or 

households. 

Estimated Annual Burden: 610,833 

hours. 

Estimated Average Burden per 

Respondent: 10 minutes. 

Frequency of Response: Once 

annually. 

Estimated Number of Respondents: 

3,665,000. 

VA Form 10–10143a 

Affected Public: Individuals or 

households. 

Estimated Annual Burden: 610,833 

hours. 

Estimated Average Burden per 

Respondent: 10 minutes. 

Frequency of Response: Once 

annually. 

Estimated Number of Respondents: 

3,665,000. 

VA Form 10–10143b 

Affected Public: Private Sector. 

Estimated Annual Burden: 1,039,332 

hours. 

Estimated Average Burden per 

Respondent: 5 minutes. 

Frequency of Response: Average of 34 

times annually. 

Estimated Number of Respondents: 

366,823. 

VA Form 10–10143c 

Affected Public: Private Sector. 

Estimated Annual Burden: 10,190 

hours. 

Estimated Average Burden per 

Respondent: 5 minutes. 

Frequency of Response: Once 

annually. 

Estimated Number of Respondents: 

122,274. 

VA Form 10–10143e 

Affected Public: Private Sector. 

Estimated Annual Burden: 611,372 

hours. 

Estimated Average Burden per 

Respondent: 20 minutes. 

Frequency of Response: Average of 5 

times annually. 

Estimated Number of Respondents: 

366,823. 

VA Form 10–10143f 

Affected Public: Private Sector. 

Estimated Annual Burden: 41,667 

hours. 

Estimated Average Burden per 

Respondent: 5 minutes. 

Frequency of Response: Once 

annually. 

Estimated Number of Respondents: 

500,000. 

VA Form 10–10143g 

Affected Public: Private Sector. 

Estimated Annual Burden: 83,333 

hours. 

Estimated Average Burden per 

Respondent: 10 minutes. 

Frequency of Response: Once 

annually. 

Estimated Number of Respondents: 

500,000. 

By direction of the Secretary. 

Danny S. Green, 

Interim VA Clearance Officer, Office of 

Quality, Performance and Risk (OQPR), 

Department of Veterans Affairs. 

[FR Doc. 2020–26575 Filed 12–1–20; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0882] 

Agency Information Collection Activity 

Under OMB Review: Chapter 31 

Request for Assistance 

AGENCY: Veterans Benefits 

Administration, Department of Veterans 

Affairs. 

ACTION: Notice. 

SUMMARY: In compliance with the 

Paperwork Reduction Act (PRA) of 

1995, this notice announces that the 

Veterans Benefits Administration, 

Department of Veterans Affairs, will 

submit the collection of information 

abstracted below to the Office of 

Management and Budget (OMB) for 

review and comment. The PRA 

submission describes the nature of the 

information collection and its expected 

cost and burden and it includes the 

actual data collection instrument. 

DATES: Written comments and 

recommendations for the proposed 

information collection should be sent 

within 30 days of publication of this 

notice to www.reginfo.gov/public/do/ 

PRAMain. Find this particular 

information collection by selecting 

‘‘Currently under 30-day Review—Open 

for Public Comments’’ or by using the 

search function. Refer to ‘‘OMB Control 

No. 2900–0882. 

FOR FURTHER INFORMATION CONTACT: 

Danny S. Green, Enterprise Records 

Service (005R1B), Department of 

Veterans Affairs, 811 Vermont Avenue 

NW, Washington, DC 20420, (202) 421– 

1354 or email danny.green2@va.gov. 

Please refer to ‘‘OMB Control No. 2900– 

0882’’ in any correspondence. 

SUPPLEMENTARY INFORMATION: 

Authority: 38 U.S.C. 3100, 38 U.S.C. 

501. 

Title: Chapter 31 Request for 

Assistance (VA Form 28–10212). 

OMB Control Number: 2900–0882.