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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8130 Federal Register / Vol. 81, No. 31 / Wednesday, February 17, 2016 / Notices 

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 

nancy.kessinger@va.gov. 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 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0745] 

Agency Information Collection 

(Application for Fee or Roster 

Personnel Designation) Activity Under 

OMB Review 

AGENCY: Veterans Benefits 

Administration, Department of Veterans 

Affairs. 

ACTION: Notice. 

SUMMARY: In compliance with the 

Paperwork Reduction Act (PRA) of 1995 

(44 U.S.C. 3501–3521), this notice 

announces that the Veterans Benefits 

Administration (VBA), Department of 

Veterans Affairs, will submit the 

collection of information abstracted 

below to the Office of Management and 

Budget (OMB) for review and comment. 

The PRA submission describes the 

nature of the information collection and 

its expected cost and burden; it includes 

the actual data collection instrument. 

DATES: Comments must be submitted on 

or before March 18, 2016. 

ADDRESSES: Submit written comments 

on the collection of information through 

www.Regulations.gov, or to Office of 

Information and Regulatory Affairs, 

Office of Management and Budget, Attn: 

VA Desk Officer; 725 17th St. NW., 

Washington, DC 20503 or sent through 

electronic mail to oira_submission@

omb.eop.gov. Please refer to ‘‘OMB 

Control No. 2900–0745’’ in any 

correspondence. 

FOR FURTHER INFORMATION CONTACT: 

Crystal Rennie, Enterprise Records 

Service (005R1B), Department of 

Veterans Affairs, 810 Vermont Avenue 

NW., Washington, DC 20420, (202) 632– 

7492 or email crystal.rennie@va.gov. 

Please refer to ‘‘OMB Control No. 2900– 

0745.’’ 

SUPPLEMENTARY INFORMATION: 

Title: Request for Certificate of 

Veteran Status. 

OMB Control Number: 2900–0745. 

Type of Review: Revision of a 

currently approved collection. 

Abstract: Applicants complete VA 

form 26–8621a to apply for a position as 

a designate fee appraiser or compliance 

inspector. VA will use the data collected 

to determine the applicant’s experience 

in the real estate valuation field. 

An agency may not conduct or 

sponsor, and a person is not required to 

respond to a collection of information 

unless it displays a currently valid OMB 

control number. The Federal Register 

Notice with a 60-day comment period 

soliciting comments on this collection 

of information was published at 80 FR 

63879 on October 21, 2015. 

Title: Request for Certificate of 

Veteran Status. 

OMB Control Number: 2900–0745. 

Type of Review: Revision of a 

currently approved collection. 

Abstract: Applicants complete VA 

form 26–8621a to apply for a position as 

a designate fee appraiser or compliance 

inspector. VA will use the data collected 

to determine the applicant’s experience 

in the real estate valuation field. 

Affected Public: Individuals or 

households. 

Estimated Annual Burden: 4 hours. 

Estimated Average Burden per 

Respondent: 10 minutes. 

Frequency of Response: One-time. 


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