[Federal Register Volume 65, Number 110 (Wednesday, June 7, 2000)]
[Notices]
[Pages 36219-36220]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-14265]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0219]


Proposed Information Collection Activity: Proposed Collection; 
Comment Request

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: The Veterans Health Administration (VHA), Department of

[[Page 36220]]

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 for-
Profit.
    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