[Federal Register Volume 75, Number 39 (Monday, March 1, 2010)]
[Notices]
[Pages 9276-9277]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-4061]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0219]


Proposed Information Collection (Application for CHAMPVA 
Benefits); Comment Request

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: The Veterans Health Administration (VHA), Department of 
Veterans Affairs (VA), is announcing an opportunity for public comment 
on the proposed collection of certain information by the agency. Under 
the Paperwork Reduction Act (PRA) of 1995, Federal agencies are 
required to publish notice in the Federal Register concerning each 
proposed collection of information, including each proposed extension 
of a currently approved collection, and allow 60 days for public 
comment in response to the notice. This notice solicits comments for 
information needed to determine eligibility of persons applying for 
healthcare benefits under Civilian Health and Medical Program--VA and 
to request preauthorization of certain health care services and 
benefits for children of Vietnam veterans born with spina bifida and 
certain other covered birth defects.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before April 30, 2010.

ADDRESSES: Submit written comments on the collection of information 
through the Federal Docket Management System (FDMS) at http://www.Regulations.gov; or to Mary Stout, Veterans Health Administration 
(193E1), Department of Veterans Affairs, 810 Vermont Avenue, NW., 
Washington, DC 20420 or e-mail: <a href="/cdn-cgi/l/email-protection#93fef2e1eabde0e7fce6e7d3e5f2bdf4fce5"><span class="__cf_email__" data-cfemail="4d202c3f34633e392238390d3b2c632a223b">[email protected]</span></a>. Please refer to 
``OMB Control No. 2900-0219'' in any correspondence. During the comment 
period, comments may be viewed online through FDMS.

FOR FURTHER INFORMATION CONTACT: Mary Stout at (202) 461-5867 or FAX 
(202) 273-9381.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44 
U.S.C. 3501-21), Federal agencies must obtain approval from the Office 
of Management and Budget (OMB) for each collection of information they 
conduct or sponsor. This request for comment is being made pursuant to 
Section 3506(c)(2)(A) of the PRA.
    With respect to the following collection of information, VHA 
invites comments on: (1) Whether the proposed collection of information 
is necessary for the proper performance of VHA's functions, including 
whether the information will have practical utility; (2) the accuracy 
of VHA's estimate of the burden of the proposed collection of 
information; (3) ways to enhance the quality, utility, and clarity of 
the information to be collected; and (4) ways to minimize the burden of 
the collection of information on respondents, including through the use 
of automated collection techniques or the use of other forms of 
information technology.
    Titles:
    a. Application for CHAMPVA Benefits, VA Form 10-10d.
    b. CHAMPVA Claim Form, VA Form 10-7959a.
    c. CHAMPVA Other Health Insurance (OHI) Certification, VA Form 10-
7959c.
    d. CHAMPVA Potential Liability Claim, VA Form 10-7959d.
    e. Claim for Miscellaneous Expenses, VA Form 10-7959e
    OMB Control Number: 2900-0219.
    Type of Review: Extension of a currently approved collection.
    Abstracts:
    a. VA Form 10-10d is used to determine eligibility of persons 
applying for healthcare benefits under the CHAMPVA program.
    b. VA Form 10-7959a is used to accurately adjudicate and process 
beneficiaries claims for payment/reimbursement of related healthcare 
expenses.
    c. VA Form 10-7959c is used to systematically obtain other health 
insurance information and to correctly coordinate benefits among all 
liable parties.
    d. VA Form 10-7959d is used to gather additional information 
relative to the injury or illness as well as third party claim 
information.
    e. Beneficiaries complete VA Form 10-7959e to claim payment/

[[Page 9277]]

reimbursement of expenses related to spina bifida and certain covered 
birth defects.
    Affected Public: Individuals or households.
    Estimated Annual Burden:
    a. VA Form 10-10d--4,411 hours.
    b. VA Form 10-7959a--37,336 hours.
    c. VA Form 10-7959c--13,456 hours.
    d. VA Form 10-7959d--467 hours.
    e. VA Form 10-7959e--725 hours
    Estimated Average Burden per Respondent:
    a. VA Form 10-10d--10 minutes.
    b. VA Form 10-7959a--10 minutes.
    c. VA Form 10-7959c--10 minutes.
    d. VA Form 10-7959d--7 minutes.
    e. VA Form 10-7959e--10 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents:
    a. VA Form 10-10d--26,468.
    b. VA Form 10-7959a--224,018.
    c. VA Form 10-7959c--80,733.
    d. VA Form 10-7959d--4,000.
    e. VA Form 10-7959e--4,400.

    Dated: February 23, 2010.

    By direction of the Secretary.
Denise McLamb,
Program Analyst, Enterprise Records Service.
[FR Doc. 2010-4061 Filed 2-26-10; 8:45 am]
BILLING CODE 8320-01-P


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