7530 Federal Register / Vol. 80, No. 27 / Tuesday, February 10, 2015 / Notices 

DATES: Written comments and 

recommendations on the proposed 

collection of information should be 

received on or before April 13, 2015. 

ADDRESSES: Submit written comments 

on the collection of information through 

Federal Docket Management System 

(FDMS) at www.Regulations.gov or to 

Dawn M. Eggers, VA Debt Management 

Center, Bishop Henry Whipple Federal 

Building, P.O. Box 11930, St. Paul, MN 

55111–0930 or email to: dawn.eggers@

va.gov. Please refer to ‘‘OMB Control 

No. 2900–0165’’ in any correspondence. 

During the comment period, comments 

may be viewed online through FDMS. 

FOR FURTHER INFORMATION CONTACT: 

Dawn M. Eggers at (612) 713–6361 or 

FAX (612) 970–5687. 

SUPPLEMENTARY INFORMATION: Under the 

PRA of 1995 (Pub. L. 104–13; 44 U.S.C. 

3501—3521), 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, OM invites 

comments on: (1) Whether the proposed 

collection of information is necessary 

for the proper performance of OM’s 

functions, including whether the 

information will have practical utility; 

(2) the accuracy of OM’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. 

Title: Financial Status Report, VA 

Form 5655. 

OMB Control Number: 2900–0165. 

Type of Review: Revision of a 

currently approved collection. 

Abstract: Claimants complete VA 

Form 5655 to report their financial 

status. VA uses the data collected to 

determine the claimant’s eligibility for a 

waiver of collection, setup a payment 

plan or for the acceptance of a 

compromise offer on their VA benefit 

debt. 

Affected Public: Individuals or 

households. 

Estimated Annual Burden: 95,570 

hours. 

Estimated Average Burden per 

Respondent: 1 hour. 

Frequency of Response: Annually. 

Estimated Number of Respondents: 

95,570. 

Dated: February 5, 2015. 

By direction of the Secretary. 

Crystal Rennie, 

Department Clearance Officer, Department of 

Veterans Affairs. 

[FR Doc. 2015–02673 Filed 2–9–15; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0826] 

Proposed Information Collection 

(Intent To File a Claim for 

Compensation and/or Pension, or 

Survivors Pension and/or DIC) Activity: 

Comment Request 

AGENCY: Veterans Benefits 

Administration, Department of Veterans 

Affairs. 

ACTION: Notice. 

SUMMARY: The Veterans Benefits 

Administration (VBA), 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 

revision of a currently approved 

collection, and allow 60 days for public 

comment in response to the notice. VA 

Form 21–0966 will be used by claimants 

and/or their authorized representatives 

to indicate an intent to file a claim for 

compensation and/or pension, or 

survivors pension and/or DIC, to 

establish an effective date for an award 

granted in association with a complete 

claim filed within 1 year of such form. 

DATES: Written comments and 

recommendations on the proposed 

collection of information should be 

received on or before April 13, 2015. 

ADDRESSES: Submit written comments 

on the collection of information through 

Federal Docket Management System 

(FDMS) at www.Regulations.gov or to 

Nancy J. Kessinger, Veterans Benefits 

Administration (20M33), Department of 

Veterans Affairs, 810 Vermont Avenue 

NW., Washington, DC 20420 or email to 

nancy.kessinger@va.gov. Please refer to 

‘‘OMB Control No. 2900–0826’’ in any 

correspondence. During the comment 

period, comments may be viewed online 

through the FDMS. 

FOR FURTHER INFORMATION CONTACT: 

Nancy J. Kessinger at (202) 632–8924 or 

FAX (202) 632–8925. 

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, VBA invites 

comments on: (1) Whether the proposed 

collection of information is necessary 

for the proper performance of VBA’s 

functions, including whether the 

information will have practical utility; 

(2) the accuracy of VBA’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. 

Title: Intent to File a Claim for 

Compensation and/or Pension, or 

Survivors Pension and/or DIC (VA Form 

21–0966). 

OMB Control Number: 2900–0826. 

Type of Review: Revision of a 

currently approved collection. 

Abstract: VA Form 21–0966 will be 

used by claimants and/or their 

authorized representatives to indicate 

intent to file a claim for compensation 

and/or disability benefits to establish an 

effective date for an award granted in 

association with a complete claim filed 

within 1 year of such form. VA will use 

this form to identify claimants in its 

internal business operational systems to 

record the date of receipt of this 

document for the purposes of 

establishing a date of claim for a 

complete claim that is filed within 1 

year. VA also uses the information to 

furnish the claimant with the 

appropriate VA form or application for 

VA benefits. 

Affected Public: Individuals or 

households. 

Estimated Annual Burden: 181,140. 

Estimated Average Burden per 

Respondent: 15 minutes. 

Frequency of Response: One time. 

Estimated Number of Respondents: 

724,561. 

Dated: February 5, 2015. 

By direction of the Secretary. 

Crystal Rennie, 

VA Clearance Officer, Department of Veterans 

Affairs. 

[FR Doc. 2015–02677 Filed 2–9–15; 8:45 am] 

BILLING CODE 8320–01–P 


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