Federal Register / Vol. 86, No. 28 / Friday, February 12, 2021 / Notices 9425 

future health care. The VA Advance 

Directive is invoked if a patient becomes 

unable to make health care decisions for 

himself or herself. Use of the VA 

Advance Directive is specified in VHA 

Handbook 1004.02, Advance Care 

Planning and Management of Advance 

Directives. Veterans’ rights to designate 

a health care agent and specify health 

care preferences in advance are codified 

in 38 CFR 17.32. This regulation also 

obligates VA to recognize advance 

directives and to use the information 

contained therein when health care 

decisions must be made for a patient 

that has lost decision making capacity. 

VA Form 10–0137 (both English and 

Spanish-English language versions) has 

a current OMB Paperwork Reduction 

Act (PRA) clearance under OMB Control 

Number 2900–0556. In addition, 2900– 

0556 now includes the collection of a 

‘‘Close Personal Friend Statement’’ for 

incapacitated Veterans who have not 

completed an Advance Directive and are 

in need of health care. When a Veteran 

is incapacitated and does not have an 

Advance Directive, the VA regulations 

allow a statement to be submitted from 

a ‘‘Close Personal Friend’’ who will be 

responsible for making health care 

decisions on behalf of the Veteran. It is 

estimated that 300 such statements will 

be collected annually. VA seeks to 

renew the PRA clearance for the 

information collection under OMB 

Control Number 2900–0556. 

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 

196 on October 8, 2020, pages 63661. 

VA Form 10–0137 

Affected Public: Individuals and 

households. 

Estimated Annual Burden: 171,811 

hours. 

Estimated Average Burden per 

Respondent: 30 minutes. 

Frequency of Response: Once 

annually. 

Estimated Number of Respondents: 

343,622. 

Close Personal Friend Statement 

Affected Public: Individuals and 

households. 

Estimated Annual Burden: 50 hours. 

Estimated Average Burden per 

Respondent: 10 minutes. 

Frequency of Response: Once 

annually. 

Estimated Number of Respondents: 

300. 

By direction of the Secretary. 

Maribel Aponte, 

VA PRA Clearance Officer, Office of 

Enterprise and Integration, Data Governance 

Analytics, Department of Veterans Affairs. 

[FR Doc. 2021–02853 Filed 2–11–21; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0091] 

Agency Information Collection Activity 

Under OMB Review: VA Health 

Benefits: Application, Update, and 

Hardship Determination 

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. 2900–0091. 

FOR FURTHER INFORMATION CONTACT: 

Maribel Aponte, Office of Enterprise 

and Integration, Data Governance 

Analytics (008), 1717 H Street NW, 

Washington, DC 20006, (202) 266–4688 

or email maribel.aponte@va.gov. Please 

refer to ‘‘OMB Control No. 2900–0091’’ 

in any correspondence. 

SUPPLEMENTARY INFORMATION: 

Authority: 44 U.S.C. 3501–21. 

Title: VA Health Benefits: 

Application, Update, and Hardship 

Determination, VA Forms 10–10EZ, 10– 

10EZR and 10–10HS. 

OMB Control Number: 2900–0091. 

Type of Review: Extension of a 

currently approved collection. 

Abstract: Title 38 U.S.C. Chapter 17 

authorizes VA to provide hospital care, 

medical services, domiciliary care, and 

nursing home care to eligible Veterans. 

Title 38 U.S.C. 1705 requires VA to 

design, establish, and operate a system 

of annual patient enrollment in 

accordance with a series of stipulated 

priorities. Title 38 U.S.C. 1722 

establishes eligibility assessment 

procedures for cost-free VA medical 

care, based on income levels, which 

determines whether nonserviceconnected and 0% service-connected 

non-compensable Veterans are able to 

defray the necessary expenses of care for 

nonservice-connected conditions. 

Further, when the Veteran projects that 

his or her attributable income for the 

current calendar year would be 

substantially below the applicable 

income thresholds, the Veteran would 

be considered unable to defray the 

expenses of care and VA may exempt 

the Veteran from the requirement to pay 

copayments for hospital or outpatient 

care. 

This collection of information is 

required to properly administer health 

benefits to eligible Veterans. 

a. VA Form 10–10EZ, Application for 

Health Benefits, is used to collect 

Veteran information during the initial 

application process for VA medical care, 

nursing home, domiciliary, dental 

benefits, etc. 

b. VA Form 10–10EZR, Health 

Benefits Update Form, is used to update 

a Veteran’s personal information, such 

as marital status, address, health 

insurance and financial information, for 

renewal of health benefits. 

c. VA Form 10–10HS, Request for 

Hardship Determination, is used to 

collect information from Veterans who 

are in a copay required status for 

hospital care and medical services, but 

due to a loss of income project their 

income for the current year will be 

substantially below the VA means test 

limits. 

These forms collect information to 

enroll a Veteran for health benefits, 

establish basic eligibility, identify 3rd 

party health insurance coverage, 

identify prescription copayment, 

provide for income verification, and 

serve as a mechanism to make changes 

upon admission for benefits or yearly 

financial updates. 

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 

209 on October 28, 2020, pages 68418 

and 68419. 

9426 Federal Register / Vol. 86, No. 28 / Friday, February 12, 2021 / Notices 

VA Form 10–10EZ 

Affected Public: Individuals and 

households. 

Estimated Annual Burden: 270,000 

hours. 

Estimated Average Burden per 

Respondent: 30 minutes. 

Frequency of Response: Annually. 

Estimated Number of Respondents: 

540,000. 

VA Form 10–10EZR 

Affected Public: Individuals and 

households. 

Estimated Annual Burden: 343,600 

hours. 

Estimated Average Burden per 

Respondent: 24 minutes. 

Frequency of Response: Annually. 

Estimated Number of Respondents: 

859,000. 

VA Form 10–10HS 

Affected Public: Individuals and 

households. 

Estimated Annual Burden: 1,750 

hours. 

Estimated Average Burden per 

Respondent: 15 minutes. 

Frequency of Response: Annually. 

Estimated Number of Respondents: 

7,000. 

By direction of the Secretary. 

Maribel Aponte, 

VA PRA Clearance Officer, Office of 

Enterprise and Integration, Data Governance 

Analytics, Department of Veterans Affairs. 

[FR Doc. 2021–02885 Filed 2–11–21; 8:45 am] 

BILLING CODE 8320–01–P