Federal Register / Vol. 72, No. 44 / Wednesday, March 7, 2007 / Notices 10303 

Estimated Average Burden per 

Respondent: 10 minutes. 

Frequency of Response: Occasion. 

Estimated Number of Respondents: 

6,329. 

Dated: February 22, 2007. 

By direction of the Secretary. 

Denise McLamb, 

Program Analyst, Records Management 

Service. 

[FR Doc. E7–4007 Filed 3–6–07; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0616] 

Agency Information Collection 

Activities Under OMB Review 

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. 3501–21), this notice 

announces that the Veterans Health 

Administration (VHA), 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 and 

includes the actual data collection 

instrument. 

DATES: Comments must be submitted on 

or before April 6, 2007. 

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–

0616’’ in any correspondence. 

For Further Information or a Copy of 

the Submission Contact: Denise 

McLamb, Records Management Service 

(005G2), Department of Veterans Affairs, 

810 Vermont Avenue, NW., 

Washington, DC 20420, (202) 565–8374, 

FAX (202) 565–7045 or e-mail: 

denise.mclamb@mail.va.gov. Please 

refer to ‘‘OMB Control No. 2900–0616.’’

SUPPLEMENTARY INFORMATION: 

Titles: 

a. Application for Furnishing LongTerm Care Services to Beneficiaries of 

Veterans Affairs, VA Form 10–1170. 

b. Residential Care Home Program—

Sponsor Application, VA Form 10–

2407. 

OMB Control Number: 2900–0616. 

Type of Review: Extension of a 

currently approved collection. 

Abstract: 

a. VA Form 10–1170 is completed by 

community agencies wishing to provide 

long term care to veterans receiving VA 

benefits. 

b. VA Form 10–2407 is an application 

used by a residential care facility or 

home that wishes to provide residential 

home care to veterans. It serves as the 

agreement between VA and the 

residential care home that the home will 

submit to an initial inspection and 

comply with VA requirements for 

residential care. 

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 

December 21, 2006 at pages 76727–

76728. 

Affected Public: Not-for-Profit 

Institutions, State, Local or Tribal 

Government. 

Estimated Annual Burden: 

a. VA Form 10–1170—83 hours. 

b. VA Form 10–2407—42 hours. 

Estimated Average Burden per 

Respondent: 

a. VA Form 10–1170—10 minutes. 

b. VA Form 10–2407—5 minutes. 

Frequency of Response: One time. 

Estimated Number of Respondents: 

a. VA Form 10–1170—500. 

b. VA Form 10–2407—500. 

Dated: February 21, 2007. 

By direction of the Secretary. 

Denise McLamb, 

Program Analyst, Records Management 

Service. 

[FR Doc. E7–4008 Filed 3–6–07; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0219] 

Agency Information Collection 

Activities Under OMB Review 

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. 3501–21), this notice 

announces that the Veterans Health 

Administration (VHA), 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 and 

includes the actual data collection 

instrument. 

DATES: Comments must be submitted on 

or before April 6, 2007. 

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–

0219’’ in any correspondence. 

FOR FURTHER INFORMATION CONTACT: 

Denise McLamb, Records Management 

Service (005G2), Department of Veterans 

Affairs, 810 Vermont Avenue, NW., 

Washington, DC 20420, (202) 565–8374, 

fax (202) 565–7870 or e-mail 

denise.mclamb@mail.va.gov. Please 

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

SUPPLEMENTARY INFORMATION: 

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. 

OMB Control Number: 2900–0219. 

Type of Review: Extension of a 

currently approved collection. 

Abstract: 

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. 

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 

November 20, 2006, at pages 67205–

67206. 


sroberts on PROD1PC70 with NOTICES