Federal Register / Vol. 75, No. 194 / Thursday, October 7, 2010 / Notices 62185 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0188] 

Proposed Information Collection 

(Claim, Authorization and Invoice for 

Prosthetic Items and Services) 

Activity: Under OMB Review 

AGENCY: Veterans Health 

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 Health 

Administration, 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 and includes 

the actual data collection instrument. 

DATES: Comments must be submitted on 

or before November 8, 2010. 

ADDRESSES: Submit written comments 

on the collection of information through 

http://www.Regulations.gov or to VA’s 

OMB Desk Officer, OMB Human 

Resources and Housing Branch, New 

Executive Office Building, Room 10235, 

Washington, DC 20503 (202) 395–7316. 

Please refer to ‘‘OMB Control No. 2900– 

0188’’ in any correspondence. 

FOR FURTHER INFORMATION CONTACT: 

Denise McLamb, Enterprise Records 

Service (005R1B), Department of 

Veterans Affairs, 810 Vermont Avenue, 

NW., Washington, DC 20420, (202) 461– 

7485, fax (202) 273–0443 or e-mail 

denise.mclamb@va.gov. Please refer to 

‘‘OMB Control No. 2900–0188.’’ 

SUPPLEMENTARY INFORMATION: 

Titles: 

a. Request to Submit Estimate, Form 

Letter 10–90. 

b. Veterans Application for Assistance 

in Acquiring Home Improvement and 

Structural Alterations, VA Form 10– 

0103. 

c. Application for Adaptive 

Equipment Motor Vehicle, VA Form 10– 

1394. 

d. Prosthetic Authorization for Items 

or Services, VA Form 10–2421. 

e. Prosthetic Service Card Invoice, VA 

Form 10–2520. 

f. Prescription and Authorization for 

Eyeglasses, VA Form 10–2914. 

OMB Control Number: 2900–0188. 

Type of Review: Extension of a 

currently approved collection. 

Abstract: The following forms are 

used to determine eligibility, prescribe, 

and authorize prosthetic devices. 

a. VA Form Letter 10–90 is used to 

obtain to estimated price for prosthetic 

devices. 

b. VA Form 10–0103 is used to 

determine eligibility/entitlement and 

reimbursement of individual claims for 

home improvement and structural 

alterations. 

c. VA Form 10–1394 is used to 

determine eligibility/entitlement and 

reimbursement of individual claims for 

automotive adaptive equipment. 

d. VA Form 10–2421 is used for the 

direct procurement of new prosthetic 

appliances and/or services. The form 

standardizes the direct procurement 

authorization process, eliminating the 

need for separate purchase orders, 

expedites patient treatment and 

improves the delivery of prosthetic 

services. 

e. VA Form 10–2520 is used by the 

vendors as an invoice and billing 

document. The form standardizes 

repair/treatment invoices for prosthetic 

services rendered and standardizes the 

verification of these invoices. The 

veteran certifies that the repairs were 

necessary and satisfactory. This form is 

furnished to vendors upon request. 

f. VA Form 10–2914 is used as a 

combination prescription, authorization 

and invoice. It allows veterans to 

purchase their eyeglasses directly. If the 

form is not used, the provisions of 

providing eyeglasses to eligible veterans 

may be delayed. 

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 on August 

6, 2010, at page 47680. 

Affected Public: Business or other for 

profit and Individuals or households. 

Estimated Total Annual Burden: 

a. Form Letter 10–90—708. 

b. VA Form 10–0103—583. 

c. VA Form 10–1394—1,000. 

d. VA Form 10–2421—67. 

e. VA Form 10–2520—47. 

f. VA Form 10–2914—3,333. 

Estimated Average Burden per 

Respondent: 

a. Form Letter 10–90—5 minutes. 

b. VA Form 10–0103—5 minutes. 

c. VA Form 10–1394—15 minutes. 

d. VA Form 10–2421—4 minutes. 

e. VA Form 10–2520—4 minutes. 

f. VA Form 10–2914—4 minutes. 

Frequency of Response: On occasion. 

Estimated Number of Respondents: 

a. Form Letter 10–90—8,500. 

b. VA Form 10–0103—7,000. 

c. VA Form 10–1394—4,000. 

d. VA Form 10–2421—1,000. 

e. VA Form 10–2520—700. 

f. VA Form 10–2914—50,000. 

Dated: October 4, 2010. 

By direction of the Secretary. 

Denise McLamb, 

Program Analyst, Enterprise Records Service. 

[FR Doc. 2010–25258 Filed 10–6–10; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0709] 

Proposed Information Collection 

(Regulation on Reduction of Nursing 

Shortages in State Homes; Application 

for Assistance for Hiring and Retaining 

Nurses at State Homes) Activities 

Under OMB Review 

AGENCY: Veterans Health 

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 Health 

Administration, 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 November 8, 2010. 

ADDRESSES: Submit written comments 

on the collection of information through 

http://www.Regulations.gov; or to VA’s 

OMB Desk Officer, OMB Human 

Resources and Housing Branch, New 

Executive Office Building, Room 10235, 

Washington, DC 20503 (202) 395–7316. 

Please refer to ‘‘OMB Control No. 2900– 

0709’’ in any correspondence. 

FOR FURTHER INFORMATION CONTACT: 

Denise McLamb, Enterprise Records 

Service (005R1B), Department of 

Veterans Affairs, 810 Vermont Avenue, 

NW., Washington, DC 20420, (202) 461– 

7485, FAX (202) 273–0443 or e-mail 

denise.mclamb@va.gov. Please refer to 

‘‘OMB Control No. 2900–0709.’’ 

SUPPLEMENTARY INFORMATION: 

Title: Regulation on Reduction of 

Nursing Shortages in State Homes; 

Application for Assistance for Hiring 

and Retaining Nurses at State Homes, 

VA Form 10–0430. 

OMB Control Number: 2900–0709. 

Type of Review: Extension of a 

currently approved collection. 


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