[Federal Register Volume 66, Number 105 (Thursday, May 31, 2001)]
[Notices]
[Pages 29632-29633]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-13624]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0188]


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) 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 extension of a currently approved collection, and allow 
60 days for public comment in response to the notice. This notice 
solicits comments on information needed to determine eligibility, 
prescribe and authorize prosthetic devices, glasses, claims for 
reimbursement for adaptation of living quarters and automotive 
equipment.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before July 30, 2001.

ADDRESSES: Submit written comments on the collection of information to 
Ann Bickoff, Veterans Health Administration (193B1), Department of 
Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420 or e-
mail <a href="/cdn-cgi/l/email-protection#d1b0bfbfffb3b8b2babeb7b791bcb0b8bdffa7b0ffb6bea7"><span class="__cf_email__" data-cfemail="43222d2d6d212a20282c2525032e222a2f6d35226d242c35">[email protected]</span></a>. Please refer to ``OMB Control No. 2900-
0188'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Ann Bickoff at (202) 273-8310.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 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. Request to Submit Estimate, Form Letter 10-90.
    b. Loan Follow-up Letter, Form Letter 10-426.
    c. Veterans Application for Assistance in Acquiring Home 
Improvement and Structural Alterations, VA Form 10-0103.
    d. Application for Adaptive Equipment Motor Vehicle, VA Form 10-
1394.
    e. Prosthetic Authorization for Items or Services, VA Form 10-2421.
    f. Prosthetic Service Card Invoice, VA Form 10-2520.
    g. Prescription and Authorization for Eyeglasses, VA Form 10-2914.
    OMB Control Number: 2900-0188.
    Type of Review: Extension of a currently approved collection.
    Abstract:
    a. Form Letter 10-90 is prepared by the VHA and issued to a 
contractor of the veteran's choice in order to solicit a price quote 
for a prosthetic device.
    b. Form Letter 10-426 is used to inventory prosthetic devices 
loaned to eligible veterans. The form letter inventories the loaned 
items and solicits information from the beneficiary to determine the 
current status, the need to replace, extend the loan period or 
terminate the loaned items.
    c. VA Form 10-0103 is used to determine eligibility/entitlement and 
reimbursement of individual claims for home improvement and structural 
alterations.
    d. VA Form 10-1394 is used to determine eligibility/entitlement and 
reimbursement of individual claims for automotive adaptive equipment.
    e. VA Form 10-2421 is used for the direct procurement of new 
prosthetic appliances and/or services and standardizes the direct 
procurement authorization process. The form eliminates the need for 
separate purchase orders, expedites patient treatment and improves the 
delivery of prosthetic services.
    f. VA Form 10-2520 is used by the commercial vendors after 
completing repairs authorized for veterans by their Prosthetic Service 
Card to request payment by VA. The form standardizes repair/treatment 
invoices for prosthetic services rendered and standardizes the 
verification of these invoices. The veteran certifies that the repairs 
were necessary and satisfactory. This form is furnished to vendors upon 
request.

[[Page 29633]]

    g. VA Form 10-2914 is used as a combination prescription, 
authorization and invoice. It allows veterans to purchase their 
eyeglasses directly. If the form is not used, the provisions of 
providing eyeglasses to eligible veterans may be delayed.
    Affected Public: Business or other for profit and Individuals or 
households.
    Estimated Total Annual Burden: 37,079 hours.
    a. Form Letter 10-90--1,875.
    b. Form Letter 10-426--242.
    c. VA Form 10-0103--583.
    d. VA Form 10-1394--2,711.
    e. VA Form 10-2421--16,667.
    f. VA Form 10-2520--3,334.
    g. VA Form 10-2914--11,667.
    Estimated Average Burden Per Respondent:
    a. Form Letter 10-90--5 minutes.
    b. Form Letter 10-426--1 minute.
    c. VA Form 10-0103--5 minutes.
    d. VA Form 10-1394--15 minutes.
    e. VA Form 10-2421--4 minutes.
    f. VA Form 10-2520--5 minutes.
    g. VA Form 10-2914--4 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents: 519,844.
    a. Form Letter 10-90--22,500.
    b. Form Letter 10-426--14,500.
    c. VA Form 10-0103--7,000.
    d. VA Form 10-1394--10,844
    e. VA Form 10-2421--250,000.
    f. VA Form 10-2520--40,000.
    g. VA Form 10-2914--175,000.

    Dated: May 22, 2001.
Donald L. Neilson,
Director, Information Management Service.
[FR Doc. 01-13624 Filed 5-30-01; 8:45 am]
BILLING CODE 8320-01-P


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