Federal Register / Vol. 60, No. 84 / Tuesday, May 2, 1995 / Notices 21585

expected to attend and pay their own

way to four subcommittee meetings

each year; these meetings are generally

held in Washington, DC or New York,

NY.

The IRS is interested in representation

from different areas of the payer

community (e.g., banking, data

processing, mutual funds, securities, life

insurance, public accounting, payroll,

and state & local government, etc.).

Anyone wishing to be considered for

membership on IRPAC should so advise

the IRS. Please complete the following

application questionnaire (or a facsimile

thereof prepared on a word processor),

and forward it to Ms. Kate LaBuda of the

Office Payer Compliance, at the address

below.

ADDRESSES: Internal Revenue Service,

CP:CO:SC:P, 1111 Constitution Avenue,

NW., room 2013, Washington, DC

20224.

DATES: Completed questionnaires (or

facsimiles) should be received by IRS no

later than June 30, 1995. Questionnaires

received after this date will not be

considered. An acknowledgment letter

will be sent upon receipt.

FOR FURTHER INFORMATION CONTACT:

Kate LaBuda at 202–622–3404 (not a

toll-free number).

Dated: April 19, 1995.

Larry Faulkner,

Director, Office of Payer Compliance, Service

Center Compliance.

Information Reporting Program

Advisory Committee Membership

Application Questionnaire

The following questions must be

answered by anyone interested in

becoming a member of the Information

Reporting Program Advisory Committee

(IRPAC). Applications (or facsimiles

produced on a word processor) must be

received at the address listed below by

June 30, 1995. Those received after this

date will not be considered. All

applications received will be

acknowledged. Questions may be

directed to Kate LaBuda at 202–622–

3404.

Ms. Kate LaBuda, CP:CO:SC:P, Service

Center Compliance, Internal Revenue

Service, Room 2013, 1111

Constitution Avenue NW.,

Washington, DC 20224.

1. Name:

2. Title:

3. Company or Organization Name:

4. Business Address:

5. Business Phone:

6. Fax Number:

7. Home Address:

8. Home Phone:

9. If you are applying on behalf of an

organization or association other than

your employer, please state the name,

and address of that organization. Also,

provide a letter of reference from that

organization stating that you are

nominated on their behalf. This letter

should contain the name of a contact

and this contact’s phone number.

10. List professional credentials (e.g.,

Ph.D., CPA, Enrolled Agent, Attorney,

Accountant, etc.)

11. Check the one segment of the

Information Reporting Program (IRP)

payer community to which the

organization that you represent, and

your experience, most closely relate:

lllll Real Estate

lllll Transmitter/Forms

Developer

lllll Software Developer

lllll Insurance: Property &

Casualty

lllll Insurance: Life

lllll Securities

lllll Mutual Funds

lllll Payroll

lllll State & Local Government

lllll Corporate Compliance

lllll Small Business

Compliance

lllll Public Accounting

lllll Employee Plans

lllll Trust Company

lllll Corporate Transfer Agent/

Utilities

lllll Large Financial

Institution

lllll Small Financial

Institution

lllll Other (Please specify.

llllll )

12. List the number of years of IRPrelated experience you have, and

specific sources of this IRP experience.

(Account for all years of IRP experience

claimed.)

13. Identify organizations to which

you belong and any relevant leadership

positions you have held.

14. List any previous IRS employment

(please state position/s, title/s, and

length of time in each position):

15. Please propose two topic ideas

that you feel would be appropriate for

discussion by IRPAC. Include a short

description (two sentences) of each

topic.

THE FOLLOWING THREE ITEMS

ARE REQUIRED FOR AN FBI NAME

CHECK.

16. Date of Birth:

17. Place of Birth:

18. Other names ever used:

THE FOLLOWING ITEMS ARE

REQUIRED FOR AN IRS TAX CHECK.

(PLEASE NOTE THAT A TAX CHECK

IS NOT A TAX AUDIT.)

I hereby authorize the Internal

Revenue Service to perform the

standard Federal Advisory Committee

member tax check, (pursuant to 26

U.S.C. 6103; 5 U.S.C. 1303; Executive

Orders 9397, 11222, 10450; CFR 5.2; 31

CFR Part O, Treasury Department Order

Nos. 82 (Revised) and 150–87) and to

provide this information to the Assistant

Secretary (Administration) of the

Treasury Department.

I understand that the purpose of such

tax check and income tax filing record

check is to promote public confidence

in the integrity of the Treasury

Department and its administration of

the Federal tax system. I have been

advised that my Social Security Number

is required to identify my tax records

accurately. I also understand that this

tax check must be completed prior to

my appointment to this Federal

Advisory Committee and I hereby

voluntarily provide the following

information:

19. Social Security Number:

20. Spouse’s name and SSN (if

married and filing jointly):

21. Name(s) and address(es) under

which tax returns were filed for the past

three years.

THE FOLLOWING ITEM IS

REQUIRED BECAUSE OF THE

FOREIGN AGENTS REGISTRATION

ACT (FARA), AS AMENDED.

22. I presently llll am / llll

am not required to register as an agent

of a foreign principal under FARA, as

amended.

Note: Pursuant to 18 U.S.C. sec. 219, an

individual who is required to register as an

agent of a foreign principal under FARA is

prohibited from serving on IRPAC. By

executing this questionnaire, you agree that

(1) if you are required to register as an agent

of a foreign principal under the FARA before

your term commences on IRPAC, you will

terminate any and all such agencies prior to

beginning your tenure and will provide

appropriate verification therefor; and (2) you

will immediately resign from IRPAC if you

become such an agent at any time during

your term.

Certification

23. I certify that, to the best of my

knowledge and belief, all of my

statements are true, correct, complete,

and made in good faith. I also agree to

the background checks set forth herein.

Signature llllllllllllllll

Date llllllllllllllllll

[FR Doc. 95–10764 Filed 5–1–95; 8:45 am]

BILLING CODE 4830–01–U
21586 Federal Register / Vol. 60, No. 84 / Tuesday, May 2, 1995 / Notices

DEPARTMENT OF VETERANS

AFFAIRS

Information Collections Under OMB

Review

AGENCY: Department of Veterans Affairs.

ACTION: None.

The Department of Veterans Affairs

has submitted to OMB the following

proposals for the collection of

information under the provisions of the

Paperwork Reduction Act (44 U.S.C.

Chapter 35). This document lists the

type of information collection and the

following: (1) The title of the

information collection, and the

Department form number(s), if

applicable; (2) a description of the need

and its use; (3) who will be required or

asked to respond; (4) an estimate of the

total annual reporting hours, and

recordkeeping burden, if applicable; (5)

the estimated average burden hours per

respondent; (6) the frequency of

response; and (7) an estimated number

of respondents.

ADDRESSES: Copies of the proposed

information collections and supporting

documents may be obtained from Trish

Fineran, Veterans Benefits

Administration (20M30), Department of

Veterans Affairs, 810 Vermont Avenue

NW., Washington, DC 20420, (202) 273–

6886.

Comments and questions about the

items on the list should be directed to

VA’s OMB Desk Officer, Joseph Lackey,

NEOB, Room 10102, Washington, DC

20503, (202) 395–7316. Do not send

requests for benefits to this address.

DATES: Comments on the information

collections should be directed to the

OMB Desk Officer on or before June 1,

1995.

Dated: April 24, 1995.

By direction of the Secretary.

Donald L. Neilson,

Director, Information Management Service.

Extension

1. Application for Reimbursement

from Accrued Amounts Due a Deceased

Beneficiary, VA form 21–601.

2. The form is used to file a claim for

accrued benefits available at the time of

the veteran’s death. The information is

used by Veterans Benefits

Administration to determine the

appropriate claimant eligible for

accrued benefits.

3. Individuals or households.

4. 1,875 hours.

5. 30 minutes.

6. On occasion.

7. 3,750 respondents.

Extension

1. Report and Certification of Loan

Disbursement, VA Form 26–1820.

2. This form is completed by lenders

closing VA loans under the automatic or

prior approval procedure subsequent to

issuance of guaranty.

3. Individuals or households.

4. 150,000 hours.

5. 30 minutes.

6. On occasion.

7. 300,000 respondents.

Reinstatement

1. Application for Conversion, VA

Form 29–0152.

2. The form is used by the insured to

apply for conversion of a term policy to

a permanent plan of insurance. The

information is used by Veterans Benefits

Administration to initiate the processing

of the insured’s request to convert his/

her term insurance.

3. Individuals or households.

4. 1,125 hours.

5. 15 minutes.

6. On occasion.

7. 4,500 respondents.

Reinstatement

1. Designation of Beneficiary, VA

Form 29–336.

2. The form is used by the insured to

designate a beneficiary and select an

optional settlement to be used when the

insurance matures by death. The

information is requested to determine

the claimants eligibility to receive the

proceeds.

3. Individuals or households.

4. 13,917 hours.

5. 10 minutes.

6. On occasion.

7. 83,500 respondents.

Reinstatement

1. Application of Surviving Spouse or

Child for REPS Benefits (Restored

Entitlement Program for Survivors), VA

Form 21–8924.

2. The form is used by dependents of

deceased veterans for the sole purpose

of making a claim for REPS benefits.

The information is used by Veterans

Benefits Administration to determine

whether the claimant is eligible for

REPS benefits.

3. Individuals or households.

4. 2,500 hours.

5. 20 minutes.

6. On occasion.

7. 7,000 respondents.

[FR Doc. 95–10691 Filed 5–1–95; 8:45 am]

BILLING CODE 8320–01–M

Privacy Act of 1974; Report of

Matching Programs

AGENCY: Department of Veterans Affairs

(VA).

ACTION: Notice of renewal—VA/IRS

Match Program.

SUMMARY: Notice is hereby given that

the Department of Veterans Affairs (VA),

Veterans Health Administration (VHA),

intends to renew the computer matching

program comparing Internal Revenue

Service (IRS) and Social Security

Administration (SSA) income records

with VA patient income data which is

contained in the patient medical

records.

The goal of these matches is to

compare income, social security

number, and employment status as

reported to VHA with income records

maintained by IRS and SSA. For the

information of all concerned, a

summary report of the VHA matching

program describing the computer

matches follows. In accordance with 5

U.S.C. 552a(o)(2), copies of the

computer matching report are being sent

to both houses of Congress. These

matches are expected to commence on

or about May 1, 1995, but start no

sooner than 30 days after publication of

this notice in the Federal Register, or 40

days after copies of this notice and the

agreement are submitted to Congress

and the Office of Management and

Budget. These matches may be extended

by the involved Data Integrity Boards for

a twelve month period provided all

agencies involved certify to the Data

Integrity Boards, within three months of

the termination date of the original

match, that the matching program will

be conducted without change and the

matching programs have been

conducted in compliance with the

original matching agreements. The

matches will not continue past the

legislative authorized date to obtain this

information. However, expiration of this

agreement is December 31, 1995.

ADDRESSES: Interested individuals may

comment on the matches by writing to

the Associate Chief Medical Director for

Administration (161D), Veterans Health

Administration, Department of Veterans

Affairs, 810 Vermont Avenue NW.,

Washington, DC 20420.

FOR FURTHER INFORMATION CONTACT:

Janice E. Wheeler (202) 273–6276,

Program Analyst, Income Verification

Match Policy Service.

SUPPLEMENTARY INFORMATION: Further

information regarding the matching

program is provided below. This

information is required by Title 5 U.S.C.

552a(e)(12), the Privacy Act of 1974, as