[Federal Register Volume 79, Number 246 (Tuesday, December 23, 2014)]
[Notices]
[Pages 77097-77098]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-29934]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-NEW]


Agency Information Collection (VA Meds by Mail Order Form, VA 
Form 10-0426) Activities: Under OMB Review

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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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 (VHA), 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: Written comments and recommendations on the proposed collection 
of information should be received on or before January 22, 2015.

ADDRESSES: Submit written comments on the collection of information 
through www.Regulations.gov, or to Office of Information and Regulatory 
Affairs, Office of Management and Budget, Attn: VA Desk Officer; 725 
17th St. NW., Washington, DC 20503 or sent through electronic mail to 
<a href="/cdn-cgi/l/email-protection#600f0912013f1315020d091313090f0e200f0d024e050f104e070f16"><span class="__cf_email__" data-cfemail="f996908b98a68a8c9b94908a8a909697b996949bd79c9689d79e968f">[email protected]</span></a>. Please refer to ``OMB Control No. 2900-NEW 
(VA Meds by Mail Order Form)'' in any correspondence. During the 
comment period, comments may be viewed online through the FDMS.

FOR FURTHER INFORMATION CONTACT: Crystal Rennie, Enterprise Records 
Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue 
NW., Washington, DC 20420, (202) 632-7492 or email 
<a href="/cdn-cgi/l/email-protection#096a7b707a7d6865277b6c6767606c497f68276e667f"><span class="__cf_email__" data-cfemail="f291808b8186939edc80979c9c9b97b28493dc959d84">[email protected]</span></a>. Please refer to ``OMB Control No. 2900-NEW (VA 
Meds by Mail)'' in any correspondence.

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: VA Meds by Mail Order Form.
    OMB Control Number: 2900-NEW (VA Meds by Mail Order Form, VA Form 
10-0426).
    Type of Review: New collection.
    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 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.

[[Page 77098]]

    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.
    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 October 8, 2014, at page 60896.
    Affected Public: Individuals or households.
    Estimated Annual Burden: 9,167 burden hours.
    Estimated Average Burden Per Respondent: 5 minutes.
    Frequency of Response: Yearly.
    Estimated Number of Respondents: 110,000.


    Dated: December 17, 2014.

    By direction of the Secretary.
Crystal Rennie,
VA Clearance Officer, Department of Veterans Affairs.
[FR Doc. 2014-29934 Filed 12-22-14; 8:45 am]
BILLING CODE 8320-01-P


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