Federal Register / Vol. 75, No. 234 / Tuesday, December 7, 2010 / Notices 76081 

NW., Washington, DC 20420, (202) 461– 

7485, fax (202) 273–0443 or e-mail 

denise.mclamb@va.gov. Please refer to 

‘‘OMB Control No. 2900–0080.’’ 

SUPPLEMENTAL INFORMATION: 

Titles: 

a. Claim for Payment of Cost of 

Unauthorized Medical Services, VA 

Form 10–583. 

b. Funeral Arrangements Form for 

Disposition of Remains of the Deceased, 

VA Form 10–2065. 

c. Authority and Invoice for Travel by 

Ambulance or Other Hired Vehicle, VA 

Form 10–2511. 

d. Authorization and Invoice for 

Medical and Hospital Services, VA 

Form 10–7078. 

e. Request for Payment of Beneficiary 

Travel after the Date of Service. 

OMB Control Number: 2900–0080. 

Type of Review: Revision of a 

currently approved collection. 

Abstract: 

a. VA Form 10–583 is used to request 

payment or reimbursement of the cost of 

unauthorized non-VA medical services. 

b. VA Form 10–2065 is completed by 

VA personnel during an interview with 

relatives of the deceased, and to identify 

the funeral home to which the remains 

are to be released. The form is also used 

as a control document when VA is 

requested to arrange for the 

transportation of the deceased from the 

place of death to the place of burial, 

and/or when burial is requested in a 

National Cemetery. 

c. VA Form 10–2511 is used to 

process payment for ambulance or other 

hired vehicular forms of transportation 

for eligible veterans to and from VA 

health care facilities for examination, 

treatment or care. 

d. VA uses VA Form 10–7078 to 

authorize expenditures from the 

medical care account and process 

payment of medical and hospital 

services provided by other than Federal 

health providers to VA beneficiaries. 

e. Claimants who request payment for 

beneficiary travel after the time of 

service may do so in writing or in 

person. 

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 on 

September 29, 2010, at page 60170. 

Affected Public: Business or other for 

profit. 

Estimated Total Annual Burden: 

a. VA Form 10–583—17,188. 

b. VA Form 10–2065—2,053. 

c. VA Form 10–2511—2,333. 

d. VA Form 10–7078—8,400. 

e. Request for Payment of Beneficiary 

Travel after the Date of Service—417. 

Estimated Average Burden Per 

Respondent: 

a. VA Form 10–583—15 minutes. 

b. VA Form 10–2065—5 minutes. 

c. VA Form 10–2511—2 minutes 

d. VA Form 10–7078—2 minutes. 

e. Request for Payment of Beneficiary 

Travel after the Date of Service—1 

minute. 

Frequency of Response: Annually. 

Estimated Number of Respondents: 

a. VA Form 10–583—68,750 

respondents. 

b. VA Form 10–2065—24,630 

respondents. 

c. VA Form 10–2511—70,000 

respondents. 

d. VA Form 10–7078—252,000 

respondents. 

e. Request for Payment of Beneficiary 

Travel after the Date of Service—25,000. 

Dated: December 1, 2010. 

By direction of the Secretary. 

Denise McLamb, 

Program Analyst, Enterprise Records Service. 

[FR Doc. 2010–30551 Filed 12–6–10; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0749] 

Agency Information Collection 

(Disability Benefits Questionnaires) 

Activity Under OMB Review 

AGENCY: Veterans Benefits 

Administration, Department of Veterans 

Affairs. 

ACTION: Notice. 

SUMMARY: In compliance with the 

Paperwork Reduction Act (PRA) of 1995 

(44 U.S.C. 3501–3521), this notice 

announces that the Veterans Benefits 

Administration (VBA), 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; it includes 

the actual data collection instrument. 

DATE: Comments must be submitted on 

or before January 6, 2011. 

ADDRESSES: Submit written comments 

on the collection of information through 

http://www.Regulations.gov or to VA’s 

OMB Desk Officer, OMB Human 

Resources and Housing Branch, New 

Executive Office Building, Room 10235, 

Washington, DC 20503 (202) 395–7316. 

Please refer to ‘‘OMB Control No. 2900– 

0749’’ in any correspondence. 

FOR FURTHER INFORMATION CONTACT: 

Denise McLamb, Enterprise Records 

Service (005R1B), Department of 

Veterans Affairs, 810 Vermont Avenue, 

NW., Washington, DC 20420, (202) 461– 

7485, FAX (202) 273–0443 or e-mail 

denise.mclamb@va.gov. Please refer to 

‘‘OMB Control No. 2900–0749.’’ 

SUPPLEMENTAL INFORMATION: 

Titles: 

a. Ischemic Heart Disease (IHD) 

Disability Benefits Questionnaire, VA 

Form 21–0960a–1. 

b. Hairy Cell and Other B-Cell 

Leukemias Disability Benefits 

Questionnaire, VA Form 21–0960b–1. 

c. Parkinson’s Disease Disability 

Benefits Questionnaire, VA Form 21– 

0960c–1. 

OMB Control Number: 2900–0749. 

Type of Review: Extension of a 

currently approved collection. 

Abstract: VA Forms 21–0960a–1, 21– 

0960b–1, and 21–0960b–1 are used to 

expedite claims for the following 

presumptive diseases based on 

herbicide exposure: Hairy Cell and 

Other Chronic B-cell Leukemias, 

Parkinson’s and Ischemic Heart 

diseases. Veterans have the option of 

providing the forms to their private 

physician for completion and 

submission to VA in lieu of scheduling 

a VA medical examination. The data 

collected will be used to adjudicate 

veterans claim for disability benefits. 

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 on 

September 29, 2010, at pages 60170– 

60171. 

Affected Public: Individuals or 

households. 

Estimated Annual Burden: 

a. Ischemic Heart Disease (IHD) 

Disability Benefits Questionnaire, VA 

Form 21–0960a–1—13,750. 

b. Hairy Cell and Other B-Cell 

Leukemias Disability Benefits 

Questionnaire, VA Form 21–0960b–1— 

500. 

c. Parkinson’s Disease Disability 

Benefits Questionnaire, VA Form 21– 

0960c–1—1,250. 

Estimated Average Burden per 

Respondent: 15 minutes. 

Frequency of Response: On occasion. 

Estimated Number of Respondents: 

a. Ischemic Heart Disease (IHD) 

Disability Benefits Questionnaire, VA 

Form 21–0960a–1—55,000. 


emcdonald on DSK2BSOYB1PROD with NOTICES
76082 Federal Register / Vol. 75, No. 234 / Tuesday, December 7, 2010 / Notices 

b. Hairy Cell and Other B-Cell 

Leukemias Disability Benefits 

Questionnaire, VA Form 21–0960b–1— 

2,000. 

c. Parkinson’s Disease Disability 

Benefits Questionnaire, VA Form 21– 

0960c–1—5,000. 

Dated: December 1, 2010. 

By direction of the Secretary. 

Denise McLamb, 

Program Analyst, Enterprise Records Service. 

[FR Doc. 2010–30552 Filed 12–6–10; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0546] 

Agency Information Collection; 

Gravesite Reservation Survey (2-Year) 

Activity Under OMB Review 

AGENCY: Veterans Benefits 

Administration, Department of Veterans 

Affairs. 

ACTION: Notice. 

SUMMARY: In compliance with the 

Paperwork Reduction Act (PRA) of 1995 

(44 U.S.C. 3501–3521), 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 includes 

the actual data collection instrument. 

DATE: Comments must be submitted on 

or before January 6, 2011. 

ADDRESSES: Submit written comments 

on the collection of information through 

http://www.Regulations.gov; or to VA’s 

OMB Desk Officer, OMB Human 

Resources and Housing Branch, New 

Executive Office Building, Room 10235, 

Washington, DC 20503 (202) 395–7316. 

Please refer to ‘‘OMB Control No. 2900– 

0546’’ in any correspondence. 

FOR FURTHER INFORMATION CONTACT: 

Denise McLamb, Enterprise Records 

Service (005R1B), Department of 

Veterans Affairs, 810 Vermont Avenue, 

NW., Washington, DC 20420, (202) 461– 

7485, fax (202) 273–0443 or e-mail 

denise.mclamb@va.gov. Please refer to 

‘‘OMB Control No. 2900–0546’’ In any 

correspondence. 

SUPPLEMENTAL INFORMATION: 

Title: Gravesite Reservation Survey 

(2-Year), VA Form 40–40. 

OMB Control Number: 2900–0546. 

Type of Review: Extension of a 

currently approved collection. 

Abstract: VA Form Letter 40–40 is 

sent biennially to individuals holding 

gravesite set-asides to ascertain their 

wish to retain the set-aside, or 

relinquish it. Gravesite reservation 

surveys are necessary as some holders 

become ineligible, are buried elsewhere, 

or simply wish to cancel a gravesite setaside. The survey is conducted to assure 

that gravesite set-asides do not go 

unused. 

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 on 

September 29, 2010, at page 60172. 

Affected Public: Individuals or 

households, Business or other for profit. 

Estimated Annual Burden: 2,750. 

Estimated Average Burden per 

Respondent: 10 minutes. 

Frequency of Response: Biennially. 

Estimated Number of Respondents: 

16,500. 

Dated: December 1, 2010. 

By direction of the Secretary. 

Denise McLamb, 

Program Analyst, Enterprise Records Service. 

[FR Doc. 2010–30554 Filed 12–6–10; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0521] 

Agency Information Collection (Credit 

Underwriting Standards and 

Procedures for Processing VA 

Guaranteed Loans) Activity Under 

OMB Review 

AGENCY: Veterans Benefits 

Administration, Department of Veterans 

Affairs. 

ACTION: Notice. 

SUMMARY: In compliance with the 

Paperwork Reduction Act (PRA) of 1995 

(44 U.S.C. 3501–3521), this notice 

announces that the Veterans Benefits 

Administration (VBA), 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; it includes 

the actual data collection instrument. 

DATES: Comments must be submitted on 

or before January 6, 2011. 

ADDRESSES: Submit written comments 

on the collection of information through 

http://www.Regulations.gov or to VA’s 

OMB Desk Officer, OMB Human 

Resources and Housing Branch, New 

Executive Office Building, Room 10235, 

Washington, DC 20503, (202) 395–7316. 

Please refer to ‘‘OMB Control No. 2900– 

0521’’ in any correspondence. 

FOR FURTHER INFORMATION CONTACT: 

Denise McLamb, Enterprise Records 

Service (005R1B), Department of 

Veterans Affairs, 810 Vermont Avenue, 

NW., Washington, DC 20420, (202) 461– 

7485, FAX (202) 273–0443 or e-mail 

denise.mclamb@.va.gov. Please refer to 

‘‘OMB Control No. 2900–0521.’’ 

SUPPLEMENTARY INFORMATION: 

Titles: 

a. Report and Certification of Loan 

Disbursement, VA Form 26–1820. 

b. Request for Verification of 

Employment, VA Form 26–8497. 

c. Request for Verification of Deposit, 

VA Form 26–8497a. 

OMB Control Number: 2900–0521. 

Type of Review: Extension of a 

currently approved collection. 

Abstract: Lenders must obtain specific 

information concerning a veteran’s 

credit history in order to properly 

underwrite the veteran’s loan. VA loans 

may not be guaranteed unless the 

veteran is a satisfactory credit risk. The 

data collected on the following forms 

are used to ensure that applications for 

VA-guaranteed loans are underwritten 

in a reasonable and prudent manner. 

a. VA Form 26–1820 is completed by 

lenders closing VA guaranteed and 

insured loans under the automatic or 

prior approval procedures. 

b. VA Form 26–8497 is used by 

lenders to verify a loan applicant’s 

income and employment information 

when making guaranteed and insured 

loans. VA does not require the exclusive 

use of this form for verification 

purposes, any alternative verification 

document would be acceptable 

provided that all information requested 

on VA Form 26–8497 is provided. 

c. Lenders making guaranteed and 

insured loans complete VA Form 26– 

8497a to verify the applicant’s deposits 

in banks and other savings institutions. 

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 on 

September 29, 2010, at pages 60171– 

60172. 

Affected Public: Business or other for 

profit. 

Estimated Annual Burden: 


emcdonald on DSK2BSOYB1PROD with NOTICES