[Federal Register Volume 81, Number 31 (Wednesday, February 17, 2016)]
[Notices]
[Pages 8129-8130]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-03207]


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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.

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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

[[Page 8130]]

anus condition, which includes hemorrhoids; VAF 21-0960K-1 Breast 
Conditions and Disorders Disability Benefits Questionnaire, will gather 
information related to the claimant's diagnosis of a breast condition 
or disorder; VAF 21-0960K-2 Gynecological Conditions Disability 
Benefits Questionnaire, will gather information related to the 
claimant's diagnosis of a gynecological condition; VAF 21-0960L-2, 
Sleep Apnea Disability Benefits Questionnaire, will gather information 
related to the claimant's diagnosis of sleep apnea; VAF 21-0960M-11, 
Osteomyelitis Disability Benefits Questionnaire, will gather 
information related to the claimant's diagnosis of osteomyelitis; VAF 
21-0960N-1, Ear Conditions (Including Vestibular and Infectious) 
Disability Benefits Questionnaire, will gather information related to 
the claimant's diagnosis of an ear disease.

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 <a href="/cdn-cgi/l/email-protection#d8b6b9b6bba1f6b3bdababb1b6bfbdaa98aeb9f6bfb7ae"><span class="__cf_email__" data-cfemail="c2aca3aca1bbeca9a7b1b1abaca5a7b082b4a3eca5adb4">[email protected]</span></a>. Please refer to ``OMB Control 
No. 2900-0778'' 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 3).
    OMB Control Number: 2900-0778.
    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: 77,500.

Estimated Average Burden per Respondent

i. VAF 21-0960C-5--30 minutes
ii. VAF 21-0960C-8--15 minutes
iii. VAF 21-0960C-9--45 minutes
iv. VAF 21-0960G-1--15 minutes
v. VAF 21-0960G-2--15 minutes
vi. VAF 21-0960G-3--15 minutes
vii. VAF 21-0960G-4--15 minutes
viii. VAF 21-0960G-5--30 minutes
ix. VAF 21-0960G-6--15 minutes
x. VAF 21-0960G-7--15 minutes
xi. VAF 21-0960G-8--15 minutes
xii. VAF 21-0960H-2--15 minutes
xiii. VAF 21-0960K-1--15 minutes
xiv. VAF 21-0960K-2--30 minutes
xv. VAF 21-0960L-2--15 minutes
xvi. VAF 21-0960M-11--15 minutes
xvii. VAF 21-0960N-1--15 minutes

    Frequency of Response: One time.
    Estimated Number of Respondents: 250,000.

    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. 2016-03207 Filed 2-16-16; 8:45 am]
 BILLING CODE 8320-01-P


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