[Federal Register Volume 81, Number 31 (Wednesday, February 17, 2016)]
[Notices]
[Pages 8128-8129]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-03206]


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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.

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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 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

[[Page 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 <a href="/cdn-cgi/l/email-protection#9ff1fef1fce6b1f4faececf6f1f8faeddfe9feb1f8f0e9"><span class="__cf_email__" data-cfemail="325c535c514b1c595741415b5c5557407244531c555d44">[email protected]</span></a>. 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


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