8128 Federal Register / Vol. 81, No. 31 / Wednesday, February 17, 2016 / Notices 

DEPARTMENT OF THE TREASURY 

Submission for OMB Review; 

Comment Request 

February 11, 2016. 

The Department of the Treasury will 

submit the following information 

collection request to the Office of 

Management and Budget (OMB) for 

review and clearance in accordance 

with the Paperwork Reduction Act of 

1995, Public Law 104–13, on or after the 

date of publication of this notice. 

DATES: Comments should be received on 

or before March 18, 2016 to be assured 

of consideration. 

ADDRESSES: Send comments regarding 

the burden estimate, or any other aspect 

of the information collection, including 

suggestions for reducing the burden, to 

(1) Office of Information and Regulatory 

Affairs, Office of Management and 

Budget, Attention: Desk Officer for 

Treasury, New Executive Office 

Building, Room 10235, Washington, DC 

20503, or email at OIRA_Submission@

OMB.EOP.gov and (2) Treasury PRA 

Clearance Officer, 1750 Pennsylvania 

Ave. NW., Suite 8117, Washington, DC 

20220, or email at PRA@treasury.gov. 

FOR FURTHER INFORMATION CONTACT: 

Copies of the submissions may be 

obtained by emailing PRA@treasury.gov, 

calling (202) 622–1295, or viewing the 

entire information collection request at 

www.reginfo.gov. 

Departmental Offices 

OMB Control Number: 1505–0250. 

Type of Review: Reinstatement 

without change of a previously 

approved collection. 

Title: Application and Reports for the 

Direct Component and the Centers of 

Excellence Research Grants Program of 

the Gulf RESTORE Program. 

Abstract: Authorized under the 

Resources and Ecosystems 

Sustainability, Tourist Opportunities, 

and Revived Economies of the Gulf 

Coast States Act (RESTORE) (P.L. 112– 

141), the Department of the Treasury is 

implementing several provisions of the 

Act, more specifically the Direct 

Component and the Centers of 

Excellence Research Grants Program. 

These programs require Treasury to 

make grants from the Gulf Coast 

Restoration Trust Fund to five States 

and certain counties and parishes 

impacted by the Deepwater Horizon Oil 

Spill. The information collection will be 

used to identify eligible recipients; 

determine the appropriate amount of 

funding; ensure compliance with 

applicable laws; track grantee progress, 

and report on the effectiveness of the 

program. 

Affected Public: State, local, or tribal 

governments. 

Estimated Total Annual Burden 

Hours: 6,864. 

Brenda Simms, 

Treasury PRA Clearance Officer. 

[FR Doc. 2016–03209 Filed 2–16–16; 8:45 am] 

BILLING CODE 4810–25–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0781] 

Proposed Information Collection 

(Disability Benefits Questionnaire 

(Group 4)) 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. 

The VA Form 21–0960 series will be 

used to gather necessary information 

from a claimant’s treating physician 

regarding the results of medical 

examinations. VA will gather medical 

information related to the claimant that 

is necessary to adjudicate the claim for 

VA disability benefits. The Disability 

Benefit Questionnaire title will include 

the name of the specific disability for 

which it will gather information. VAF 

21–0960C–3, Cranial Nerve Conditions 

Disability Benefits Questionnaire, will 

gather information related to the 

claimant’s diagnosis of any cranial 

nerve condition; VAF 21–0960C–6, 

Narcolepsy Disability Benefits 

Questionnaire, will gather information 

related to the claimant’s diagnosis of 

narcolepsy; VAF 21–0960C–7, 

Fibromyalgia Disability Benefits 

Questionnaire, will gather information 

related to the claimant’s diagnosis of 

fibromyalgia; VAF 21–0960C–11, 

Seizure Disorders (Epilepsy) Disability 

Benefits Questionnaire, will gather 

information related to the claimant’s 

diagnosis of any seizure disorder 

including epilepsy; VAF 21–0960D–1, 

Oral and Dental Conditions Including 

Mouth, Lips and Tongue (Other than 

Temporomandibular Joint Conditions) 

Disability Benefits Questionnaire, will 

gather information related to the 

claimant’s diagnosis of any oral or 

dental conditions; VAF 21–0960E–2, 

Endocrine Diseases (Other Than 

Thyroid, Parathyroid, or Diabetes 

Mellitus) Disability Benefits 

Questionnaire, will gather information 

related to the claimant’s diagnosis of 

any endocrine disease including 

cushings and acromegaly however, 

excluding diabetes; VAF 21–0960E–3, 

Thyroid & Parathyroid Conditions 

Disability Benefits Questionnaire, will 

gather information related to the 

claimant’s diagnosis of any thyroid or 

parathyroid condition; VAF 21–0960H– 

1, Hernias (Including Abdominal, 

Inguinal, and Femoral Hernias) 

Disability Benefits Questionnaire, will 

gather information related to the 

claimant’s diagnosis of abdominal, 

inguinal, or femoral hernias; VAF 21– 

0960I–2, HIV-Related Illness Disability 

Benefits Questionnaire, will gather 

information related to the claimant’s 

diagnosis of any HIV-related illness; 

VAF 21–0960I–3, Infectious Diseases 

Other Than HIV-Related Illness, 

Chronic Fatigue Syndrome, and 

Tuberculosis Disability Benefits 

Questionnaire, will gather information 

related to the claimant’s diagnosis of 

any infectious diseases; VAF 21–0960I– 

4, Systemic Lupus Erythematosus (SLE) 

and Other Autoimmune Diseases 

Disability Benefits Questionnaire, will 

gather information related to the 

claimant’s diagnosis of lupus or other 

immune disorders; VAF 21–0960I–5, 

Nutritional Deficiencies Disability 

Benefits Questionnaire, will gather 

information related to the claimant’s 

diagnosis of nutritional deficiencies; 

VAF 21–0960J–4, Urinary Tract 

(including Bladder & Urethra) 

Conditions (excluding Male 

Reproductive System) Disability Benefits 

Questionnaire, will gather information 

related to the claimant’s diagnosis of 

any urinary tract or bladder condition; 

VAF 21–0960L–1, Respiratory 

Conditions (Other than Tuberculosis & 

Sleep Apnea) Disability Benefits 

Questionnaire, will gather information 

related to the claimant’s diagnosis of 

any respiratory condition; VAF 21– 

0960N–3, Loss of Sense of Smell and/or 

Taste Disability Benefits Questionnaire, 

will gather information related to the 

claimant’s loss of sense of smell and 

taste; VAF 21–0960N–4, Sinusitis/ 

Rhinitis and Other Conditions of the 

Nose, Throat, Larynx, and Pharynx 

Disability Benefits Questionnaire, will 

gather information related to the 

claimant’s diagnosis of sinusitis/rhinitis 


asabaliauskas on DSK5VPTVN1PROD with NOTICES
Federal Register / Vol. 81, No. 31 / Wednesday, February 17, 2016 / Notices 8129 

or other diseases of the nose, throat, 

larynx, or pharynx; VAF 21–0960Q–1, 

Chronic Fatigue Syndrome Disability 

Benefits Questionnaire, will gather 

information related to the claimant’s 

diagnosis of chronic fatigue syndrome. 

DATES: Written comments and 

recommendations on the proposed 

collection of information should be 

received on or before April 18, 2016. 

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. 2900–0781’’ in any 

correspondence. 

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: Disability Benefits 

Questionnaires (Group 4). 

OMB Control Number: 2900–0781. 

Type of Review: Revision of a 

currently approved collection. 

Abstract: The VA Form 21–0960 

series will be used to gather necessary 

information from a claimant’s treating 

physician regarding the results of 

medical examinations. VA will gather 

medical information related to the 

claimant that is necessary to adjudicate 

the claim for VA disability benefits. 

Affected Public: Individuals or 

households. 

Estimated Annual Burden: 53,750. 

Estimated Average Burden per 

Respondent 

i. VAF 21–0960C–3—30 minutes 

ii. VAF 21–0960C–6—15 minutes 

iii. VAF 21–0960C–7—15 minutes 

iv. VAF 21–0960C–11—15 minutes 

v. VAF 21–0960D–1—15 minutes 

vi. VAF 21–0960E–2—15 minutes 

vii. VAF 21–0960E–3—15 minutes 

viii. VAF 21–0960H–1—15 minutes 

ix. VAF 21–0960I–2—15 minutes 

x. VAF 21–0960I–3—15 minutes 

xi. VAF 21–0960I–4—30 minutes 

xii. VAF 21–0960I–5—15 minutes 

xiii. VAF 21–0960J–4—15 minutes 

xiv. VAF 21–0960L–1—30 minutes 

xv. VAF 21–0960N–3—15 minutes 

xvi. VAF 21–0960N–4—30 minutes 

xvii. VAF 21–0960Q–1—15 minutes 

Frequency of Response: One time. 

Estimated Number of Respondents: 

160,000. 

By direction of the Secretary. 

Kathleen M. Manwell, 

Program Analyst, VA Privacy Service, Office 

of Privacy and Records Management, 

Department of Veterans Affairs. 

[FR Doc. 2016–03206 Filed 2–16–16; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0778] 

Proposed Information Collection 

(Disability Benefits Questionnaire 

(Group 3)); 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. 

The VA Form 21–0960 series will be 

used to gather necessary information 

from a claimant’s treating physician 

regarding the results of medical 

examinations. VA will gather medical 

information related to the claimant that 

is necessary to adjudicate the claim for 

VA disability benefits. The DBQ title 

will include the name of the specific 

disability for which it will gather 

information. VAF 21–0960C–5, Central 

Nervous System and Neuromusculo 

Diseases Disability Benefits 

Questionnaire, will gather information 

related to the claimant’s diagnosis of a 

central nervous system disease; VAF 

21–0960C–8, Headaches (Including 

Migraine Headaches) Disability Benefits 

Questionnaire, will gather information 

related to the claimant’s diagnosis of 

headaches; VAF 21–0960C–9, Multiple 

Sclerosis (MS) Disability Benefits 

Questionnaire, will gather information 

related to the claimant’s diagnosis of 

multiple sclerosis; VAF 21–0960G–1, 

Esophageal Disorders (including GERD, 

Hiatal Hernia, and Other Esophageal 

Disorders) Disability Benefits 

Questionnaire, will gather information 

related to the claimant’s diagnosis of 

any esophageal disorders; VAF 21– 

0960G–2, Gall Bladder and Pancreas 

Conditions Disability Benefits 

Questionnaire, will gather information 

related to the claimant’s diagnosis of 

any gall bladder and pancreas 

condition; VAF 21–0960G–3, Intestinal 

Conditions (Other than Surgical or 

Infectious) Including Irritable Bowel 

Syndrome, Crohn’s Disease, Ulcerative 

Colitis, and Diverticulitis Disability 

Benefits Questionnaire, will gather 

information related to the claimant’s 

diagnosis of any intestinal conditions 

unrelated to surgery or infection; VAF 

21–0960G–4, Infectious Intestinal 

Disorders (including Bacterial and 

Parasitic Infections) Disability Benefits 

Questionnaire, will gather information 

related to the claimant’s diagnosis of 

any infectious intestinal condition; VAF 

21–0960G–5, Hepatitis, Cirrhosis and 

other Liver Conditions Disability 

Benefits Questionnaire, will gather 

information related to the claimant’s 

diagnosis of any liver condition; VAF 

21–0960G–6, Peritoneal Adhesions 

Disability Benefits Questionnaire, will 

gather information related to the 

claimant’s diagnosis of peritoneal 

adhesions; VAF 21–0960G–7, Stomach 

and Duodenum Conditions (Not 

Including GERD or Esophageal 

Disorders) Disability Benefits 

Questionnaire, will gather information 

related to the claimant’s diagnosis of 

any stomach or duodenum conditions; 

VAF 21–0960G–8, Intestinal Surgery 

(Bowel Resection, Colostomy, 

Ileostomy) Disability Benefits 

Questionnaire, will gather information 

related to the claimant’s diagnosis of 

any surgical intestinal condition; VAF 

21–0960H–2, Rectum and Anus 

Conditions (Including Hemorrhoids) 

Disability Benefits Questionnaire, will 

gather information related to the 

claimant’s diagnosis of any rectum or 


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