[Federal Register Volume 75, Number 188 (Wednesday, September 29, 2010)]
[Notices]
[Page 60170]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-24438]



[[Page 60170]]

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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0080]


Proposed Information Collection (Claim for Payment of Cost of 
Unauthorized Medical Services) Activity: 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 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 initiate and document expenditures, 
to claim reimbursement as well as make funeral arrangements and 
authorize burial benefits.

DATES: Written comments and recommendations on the proposed collection 
of information should be received on or before November 29, 2010.

ADDRESSES: Submit written comments on the collection of information 
through http://www.Regulations.gov; or to Cynthia Harvey-Pryor, 
Veterans Health Administration (193E1), Department of Veterans Affairs, 
810 Vermont Avenue, NW., Washington, DC 20420; or e-mail: 
<a href="/cdn-cgi/l/email-protection#b6d5cfd8c2dedfd798ded7c4c0d3cf9bc6c4cfd9c4f6c0d798d1d9c0"><span class="__cf_email__" data-cfemail="6c0f15021804050d42040d1e1a0915411c1e15031e2c1a0d420b031a">[email protected]</span></a>. Please refer to ``OMB Control No. 2900-
0080'' in any correspondence. During the comment period, comments may 
be viewed online through the Federal Docket Management System (FDMS) at 
http://www.Regulations.gov.

FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor at (202) 461-5870 
or FAX (202) 273-9381.

SUPPLEMENTARY INFORMATION: Under the PRA of 1995 (Pub. L. 104-13; 44 
U.S.C. 3501--3521), 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. Claim for Payment of Cost of Unauthorized Medical Services, VA 
Form 10-583.
    b. Funeral Arrangements Form for Disposition of Remains of the 
Deceased, VA Form 10-2065.
    c. Authority and Invoice for Travel by Ambulance or Other Hired 
Vehicle, VA Form 10-2511.
    d. Authorization and Invoice for Medical and Hospital Services, VA 
Form 10-7078.
    e. Request for Payment of Beneficiary Travel After the Date of 
Service.
    OMB Control Number: 2900-0080.
    Type of Review: Extension of a currently approved collection.
    Abstracts:
    a. VA Form 10-583 is used to request payment or reimbursement of 
the cost of unauthorized non-VA medical services.
    b. VA Form 10-2065 is completed by VA personnel during an interview 
with relatives of the deceased, and to identify the funeral home to 
which the remains are to be released. The form is also used as a 
control document when VA is requested to arrange for the transportation 
of the deceased from the place of death to the place of burial, and/or 
when burial is requested in a National Cemetery.
    c. VA Form 10-2511 is used to process payment for ambulance or 
other hired vehicular forms of transportation for eligible veterans to 
and from VA health care facilities for examination, treatment or care.
    d. VA uses VA Form 10-7078 to authorize expenditures from the 
medical care account and process payment of medical and hospital 
services provided by other than Federal health providers to VA 
beneficiaries.
    e. Claimants who request payment for beneficiary travel after the 
time of service may do so in writing or in person.
    Affected Public: Business or other for profit.
    Estimated Total Annual Burden:
    a. VA Form 10-583--19,376.
    b. VA Form 10-2065--2,053.
    c. VA Form 10-2511--2,333.
    d. VA Form 10-7078--8,900.
    e. Request for Payment of Beneficiary Travel After the Date of 
Service--417.
    Estimated Average Burden per Respondent:
    a. VA Form 10-583--15 minutes.
    b. VA Form 10-2065--5 minutes.
    c. VA Form 10-2511--2 minutes
    d. VA Form 10-7078--2 minutes.
    e. Request for Payment of Beneficiary Travel After the Date of 
Service--1 minute.
    Frequency of Response: Annually.
    Estimated Number of Respondents:
    a. VA Form 10-583--77,504 respondents.
    b. VA Form 10-2065--24,630 respondents.
    c. VA Form 10-2511--70,000 respondents.
    d. VA Form 10-7078--267,021,000 respondents.
    e. Request for Payment of Beneficiary Travel After the Date of 
Service--25,000

    Dated: September 24, 2010.

    By direction of the Secretary.
Denise McLamb,
Program Analyst, Records Management Service.
[FR Doc. 2010-24438 Filed 9-28-10; 8:45 am]
BILLING CODE P


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