[Federal Register Volume 79, Number 195 (Wednesday, October 8, 2014)]
[Notices]
[Page 60896]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-23995]


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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.

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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 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: <a href="/cdn-cgi/l/email-protection#96d7e3f2e4f3efb8e4f3e0f3e4f3d6e0f7b8f1f9e0"><span class="__cf_email__" data-cfemail="2c6d59485e4955025e495a495e496c5a4d024b435a">[email protected]</span></a>. 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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