60896 Federal Register / Vol. 79, No. 195 / Wednesday, October 8, 2014 / Notices 

information; (c) ways to enhance the 

quality, utility, and clarity of the 

information to be collected; (d) ways to 

minimize the burden of the collection of 

information on respondents, including 

through the use of automated collection 

techniques or other forms of information 

technology; and (e) estimates of capital 

or start-up costs and costs of operation, 

maintenance, and purchase of services 

to provide information. 

Approved: October 2, 2014. 

Christie Preston, 

IRS Reports Clearance Officer. 

[FR Doc. 2014–24072 Filed 10–7–14; 8:45 am] 

BILLING CODE 4830–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–NEW] 

VA Meds by Mail Order Form, VA Form 

10–0426 

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 proposed 

revised collection, and allow 60 days for 

public comment in response to the 

notice. This notice solicits comments on 

information needed to obtain an 

accurate and comprehensive assessment 

of satisfaction of patients who receive 

mental health care services and on 

outcomes for Veterans who seek mental 

health treatment from VHA. Data will 

allow the program office to ensure that 

the target audience is being reached, 

effective treatments are being offered, 

and tangible, quantitative results are 

being measured and tracked for 

continual program improvement. 

DATES: Written comments and 

recommendations on the proposed 

collection of information should be 

received on or before. December 8, 2014. 

ADDRESSES: Submit written comments 

on the collection of information through 

the Federal Docket Management System 

(FDMS) at www.Regulations.gov; or to 

Audrey Revere, Office of Regulatory and 

Administrative Affairs, Veterans Health 

Administration (10B4), Department of 

Veterans Affairs, 810 Vermont Avenue 

NW., Washington, DC 20420 or email: 

Audrey.revere@va.gov. Please refer to 

‘‘OMB Control No. 2900–NEW, VA 

Meds by Mail Order Form, VA Form 10– 

0426’’ in any correspondence. During 

the comment period, comments may be 

viewed online through FDMS. 

FOR FURTHER INFORMATION CONTACT: 

Audrey Revere at (202) 461–5694. 

SUPPLEMENTARY INFORMATION: Under the 

PRA of 1995 (Pub. L. 104–13; 44 U.S.C. 

3501–3521), Federal agencies must 

obtain approval from 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. 

Title: Meds By Mail Order Form, VA 

Form 10–0426. 

OMB Control Number: 2900–NEW. 

Type of Review: New Collection 

(Request for a new OMB Control 

Number). 

Abstract: VA Form 10–0426, Meds by 

Mail (MbM) Order Form, is used by 

eligible CHAMPVA and Spina Bifida 

beneficiaries (also referred to as patient) 

in accordance with 38 CFR Sections 

17.270, 17.271 and 17.272 when 

submitting a paper prescription written 

by their medical provider for fulfillment 

through the Meds by Mail Program. 

Information collected on this form is 

necessary for proper patient 

identification and medical record 

review. 

The provisions of VHA Handbook 

1108.05, Outpatient Pharmacy Services, 

require that, as a condition for 

dispensing a prescription, the 

prescription must contain the following 

patient identifiers: 

(1) Patient’s Full Name 

(2) Social Security Number 

(3) Patient’s Current Address 

Local Meds by Mail Desk Procedure 

utilizes date of birth as an additional 

patient identifier. 

The provisions of VHA Handbook 

1108.05, Outpatient Pharmacy Services 

require pharmacists to review the 

patient medical record for the presence 

of allergy information and the potential 

for adverse drug events prior to the 

dispensing of medication to the patient. 

Affected Public: Individuals or 

Households. 

Estimated Total Annual Burden: 

18,333 hours. 

Estimated Average Burden per 

Respondent: 5 minutes. 

Frequency of Response: Yearly. 

Estimated Number of Respondents: 

110,000. 

Dated: October 3, 2014. 

By direction of the Secretary. 

Crystal Rennie, 

Department Clearance Officer, U.S. 

Department of Veterans Affairs. 

[FR Doc. 2014–23995 Filed 10–7–14; 8:45 am] 

BILLING CODE 8320–01–P 


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