Document Headings

                    Document headings vary by document type but may contain                    the following:                  
                -                       the agency or agencies that issued and signed a document                    
                -                       the number of the CFR title and the number of each part                      the document amends, proposes to amend, or is directly                      related to                    
                -                       the agency docket number / agency internal file number                    
                -                       the RIN which identifies each regulatory action listed in                      the Unified Agenda of Federal Regulatory and Deregulatory                      Actions                    

                    See the                                          Document Drafting Handbook                                        for more details.                  

###### Department of Veterans Affairs

          - [OMB Control No. 2900-0648]

# AGENCY:

Veterans Health 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 Health Administration (VHA), 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.

# DATES:

Comments must be submitted on or before September 4, 2009.

# 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. 2900-0648” 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@mail.va.gov.*                         Please refer to “OMB Control No. 2900-0648.”                    

# SUPPLEMENTARY INFORMATION:

*Titles:*

a. Foreign Medical Program (FMP) Registration Form, VA Form 10-7959f-1.

b. Claim Cover Sheet—Foreign Medical Program (FMP), VA Form 10-7959f-2.

*OMB Control Number:*                     2900-0648.                

*Type of Review:*                     Extension of a currently approve collection.                

*Abstracts:*

a. Veterans with service connected disabilities living or traveling overseas complete VA Form 10-7959f-1 to enroll in the Foreign Medical Program.

b. Healthcare providers complete VA Form 10-7959f-2 to submit claims for payments or reimbursement of expenses relating to veterans living or traveling overseas (except for the Philippines) with service-connected disability. VA will accept provider's generated billing statement, Uniform Billing-Forms (UB) 04, and Medicare Health Insurance Claims Form, CMS 1500 for payments or reimbursements.

                    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 May 22, 2009 at pages 24076-20477.                

*Estimated Total Annual Burden:*

a. Foreign Medical Program, VA Form 10-7959f-1—110 hours.

b. Claim Cover Sheet, VA Form 10-7959f-2—3,652 hours.

*Estimated Average Burden per Respondent:*

a. Foreign Medical Program, VA Form 10-7959f-1—4 minutes.

b. Claim Cover Sheet, VA Form 10-7959f-2—11 minutes.

*Frequency of Response:*                     On occasion.                

*Estimated Number of Respondents:*

a. Foreign Medical Program, VA Form 10-7959f-1—1,660.

b. Claim Cover Sheet, VA Form 10-7959f-2—19,920.

Dated: July 30, 2009.

By direction of the Secretary.

Denise McLamb,

Program Analyst, Enterprise Records Service.

[FR Doc. E9-18626 Filed 8-4-09; 8:45 am]

BILLING CODE 8320-01-P