36220 Federal Register / Vol. 65, No. 110 / Wednesday, June 7, 2000 / Notices

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

Reinstatement, with change, of a

previously approved collection for

which approval has expired, and allow

60 days for public comment in response

to the notice. This notice solicits

comments for information needed to

adjudicate and pay healthcare benefit

claims.

DATES: Written comments and

recommendations on the proposed

collection of information should be

received on or before August 7, 2000.

ADDRESSES: Submit written comments

on the collection of information to Ann

W. Bickoff, Veterans Health

Administration (193B1), Department of

Veterans Affairs, 810 Vermont Avenue,

NW., Washington, DC 20420. Please

refer to ‘‘OMB Control No. 2900–0219’’

in any correspondence.

FOR FURTHER INFORMATION CONTACT: Ann

W. Bickoff at (202) 273–8310 or Fax

(202) 273–9381.

SUPPLEMENTARY INFORMATION: Under the

PRA of 1995 (Public Law 104–13; 44

U.S.C., 3501–3520), 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. VA Spina Bifida Healthcare

Benefits, Claim for Miscellaneous

Expenses, VA Form 10–7959E.

OMB Control Number: 2900–0219.

Type of Review: Reinstatement, with

change, of a previously approved

collection for which approval has

expired.

Abstract: The following forms are

used by Civilian Health and Medical

Program-VA (CHAMPVA) and spina

bifida claimants to claim reimbursement

for medical care and by VA to determine

eligibility, process claims, detect fraud

and recover costs from third parties.

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

adjudicate claims for CHAMPVA

benefits.

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

recover costs associated with healthcare

services related to injury or illness

caused by a third party.

e. VA Form 10–7959E is used by VA

Spina Bifida Healthcare beneficiaries to

claim payment or reimbursement for

healthcare services and related travel

expenses.

Affected Public: Individuals or

Households, Business or Other forProfit.

Estimated Annual Burden: 60,467

hours.

a. VA Form 10–10D—1,500 hours.

b. VA Form 10–7959A—50,000 hours.

c. VA Form 10–7959C—6,200 hours.

d. VA Form 10–7959D—1,167 hours.

e. VA Form 10–7959E—1,600 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—6 minutes.

d. VA Form 10–7959D—7 minutes.

e. VA Form 10–7959E—4 minutes.

Frequency of Response: On occasion.

Estimated Number of Respondents:

405,000.

a. VA Form 10–10D—9,000.

b. VA Form 10–7959A—300,000.

c. VA Form 10–7959C—62,000.

d. VA Form 10–7959D—10,000.

e. VA Form 10–7959E—24,000.

Dated: May 11, 2000.

By direction of the Secretary:

Donald L. Neilson,

Director, Information Management Service.

[FR Doc. 00–14265 Filed 6–6–00; 8:45 am]

BILLING CODE 8320–01–P

DEPARTMENT OF VETERANS

AFFAIRS

[OMB Control No. 2900–0098]

Agency Information Collection

Activities 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 et seq.), this notice

announces that the Veterans Benefits

Administration (VBA), Department of

Veterans Affairs, has submitted 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 July 7, 2000.

FOR FURTHER INFORMATION OR A COPY OF

THE SUBMISSION CONTACT: Denise

McLamb, Information Management

Service (045A4), Department of

Veterans Affairs, 810 Vermont Avenue,

NW., Washington, DC 20420, (202) 273–

8030 or FAX (202) 273–5981. Please

refer to ‘‘OMB Control No. 2900–0098.’’

SUPPLEMENTARY INFORMATION:

Title: Application for Survivors’ and

Dependents’ Educational Assistance

(Under Provisions of Chapter 35, Title

38, U.S.C.), VA Form 22–5490.

OMB Control Number: 2900–0098.

Type of Review: Extension of a

currently approved collection.

Abstract: VA Form 22–5490 serves as

an application for Dependents’

Educational Assistance (DEA). Spouses,

surviving spouses, and children of

veterans must submit evidence to

establish eligibility and entitlement to

DEA under Title 38, U.S.C., 3513. VA

uses the information to determine if an

individual claimant qualifies for DEA

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 March

9, 2000 at page 12627.

Affected Public: Individuals or

households.

Estimated Annual Burden: 10,050

hours.

Estimated Average Burden Per

Respondent: 30 minutes.

Federal Register / Vol. 65, No. 110 / Wednesday, June 7, 2000 / Notices 36221

Frequency of Response: Once—Initial

Application.

Estimated Number of Respondents:

20,100.

Send comments and

recommendations concerning any

aspect of the information collection to

VA’s OMB Desk Officer, Allison Eydt,

OMB Human Resources and Housing

Branch, New Executive Office Building,

Room 10235, Washington, DC 20503

(202) 395–4650. Please refer to ‘‘OMB

Control No. 2900–0098’’ in any

correspondence.

Dated: May 18, 2000.

By direction of the Secretary.

Donald L. Neilson,

Director, Information Management Service.

[FR Doc. 00–14264 Filed 6–6–00; 8:45 am]

BILLING CODE 8320–01–P