60170 Federal Register / Vol. 75, No. 188 / Wednesday, September 29, 2010 / Notices 

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. 

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: 

cynthia.harvey-pryor@va.gov. 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 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0749] 

Proposed Information Collection 

(Disability Benefits Questionnaires) 

Activity: Comment Request 

AGENCY: Veterans Benefits 

Administration, Department of Veterans 

Affairs. 

ACTION: Notice. 

SUMMARY: The Veterans Benefits 

Administration (VBA) 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 

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 adjudicate a claim for 

disability 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 


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