Federal Register / Vol. 74, No. 123 / Monday, June 29, 2009 / Notices 31111 

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 

revision 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 assess the health care 

disability compensation or 

rehabilitation needs of Former Prisoners 

of War (FPOW) veteran. 

DATES: Written comments and 

recommendations on the proposed 

collection of information should be 

received on or before August 28, 2009. 

ADDRESSES: Submit written comments 

on the collection of information through 

Federal Docket Management System 

(FDMS) at http://www.Regulations.gov; 

or to Mary Stout, Veterans Health 

Administration (193E1), Department of 

Veterans Affairs, 810 Vermont Avenue, 

NW., Washington, DC 20420 or e-mail: 

mary.stout@va.gov. Please refer to 

‘‘OMB Control No. 2900–0427’’ in any 

correspondence. During the comment 

period, comments may be viewed online 

through FDMS. 

FOR FURTHER INFORMATION CONTACT: 

Mary Stout (202) 461–5867 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. 

Title: Former POW Medical History, 

VA Form 10–0048. 

OMB Control Number: 2900–0427. 

Type of Review: Revision of a 

currently approved collection. 

Abstract: VA Form 10–0048 is 

completed by a VA physician during a 

medical examination of a Former 

Prisoner of War veteran. VA will use the 

data collected as a guide and reference 

for treatment planning for the FPOW 

veteran. 

Affected Public: Individuals or 

households. 

Estimated Total Annual Burden: 113 

hours. 

Estimated Average Burden per 

Respondent: 90 minutes. 

Frequency of Response: One time. 

Estimated Number of Respondents: 

75. 

Dated: June 24, 2009. 

By direction of the Secretary. 

Denise McLamb, 

Program Analyst, Enterprise Records Service. 

[FR Doc. E9–15273 Filed 6–26–09; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0017] 

Proposed Information Collection 

(Annual-Final Report and Account) 

Activity: Comment Request 

AGENCY: Veterans Benefits 

Administration, Department of Veterans 

Affairs. 

ACTION: Notice. 

SUMMARY: The Veterans Benefits 

Administration (VBA), Department of 

Veterans Affairs (VA), 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 the 

information needed to ensure that 

fiduciaries are properly administering 

VA beneficiaries’ compensation and 

pension payments. 

DATES: Written comments and 

recommendations on the proposed 

collection of information should be 

received on or before August 28, 2009. 

ADDRESSES: Submit written comments 

on the collection of information through 

the Federal Docket Management System 

(FDMS) at http://www.Regulations.gov 

or to Nancy J. Kessinger, Veterans 

Benefits Administration (20M35), 

Department of Veterans Affairs, 810 

Vermont Avenue, NW., Washington, DC 

20420 or e-mail to 

nancy.kessinger@va.gov. Please refer to 

‘‘OMB Control No. 2900–0017’’ in any 

correspondence. During the comment 

period, comments may be viewed online 

through FDMS. 

FOR FURTHER INFORMATION CONTACT: 

Nancy J. Kessinger at (202) 461–9769 or 

FAX (202) 275–5947. 

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, VBA invites 

comments on: (1) Whether the proposed 

collection of information is necessary 

for the proper performance of VBA’s 

functions, including whether the 

information will have practical utility; 

(2) the accuracy of VBA’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. Annual-Final Report and Account, 

VA Form 21–4706. 

b. Federal Fiduciary’s Account, VA 

Form 21–4706b. 

c. Court Appointed Fiduciary’s 

Account, VA Form 21–4706c. 

d. Account Book, VA Form 21–4718. 

e. Certificate of Balance on Deposit 

and Authorization to Disclose Financial 

Records (Pursuant to Title 38, U.S.C., 

Chapter 55 and Title 12, U.S.C., Chapter 

35), VA Form 27–4718a. 

OMB Control Number: 2900–0017. 

Type of Review: Extension of a 

currently approved collection. 

Abstract: VA maintains supervision of 

the distribution and use of VA benefits 

paid to fiduciaries on behalf of VA 

claimants who are incompetent, a 

minor, or under legal disability. The 

forms are used to verify beneficiaries’ 

deposit remaining at a financial 

institution against a fiduciary’s 

accounting. The following forms will be 

used to ensure claimants’ benefits 

payments are administered properly. 

a. VA Forms 21–4706, 4706b and 

4706c are used by estate to determine 


sroberts on PROD1PC70 with NOTICES
31112 Federal Register / Vol. 74, No. 123 / Monday, June 29, 2009 / Notices 

proper usage of benefits paid to 

fiduciaries. The 21–4706 and 21–4706b 

are both necessary to conform to 

requirement of various state courts. 

b. VA Form 21–4718 is provided to 

VA fiduciaries to submit accountings to 

either State courts or the VA. It is not 

a reporting form per se, but a vehicle to 

assist the fiduciary in accurately 

maintaining records of monies received 

and spent. 

c. VA Form 21–4718a—Fiduciaries 

are required to obtain certifications that 

the balances remaining on deposit in 

financial institutions as shown on 

accountings are correct. Certifying 

official at a financial institution 

completing the form must affix the 

institution’s official seal or stamp. The 

data collected is used to appoint an 

appropriate fiduciary for a VA 

beneficiary and to prevent fiduciaries 

from supplying false certification, 

embezzling funds, and possibly prevent 

and/or identify fraud, waste and abuse 

of government funds paid to fiduciaries 

on behalf of VA beneficiaries. 

Affected Public: Individuals or 

households. 

Estimated Annual Burden: 

a. Annual-Final Report and Account, 

VA Form 21–4706—1,100. 

b. Federal Fiduciary’s Account, VA 

Form 21–4706b—6,300. 

c. Court Appointed Fiduciary’s 

Account, VA Form 21–4706c—2,000. 

d. Account Book, VA Form 21–4718— 

20,000. 

e. Certificate of Balance on Deposit 

and Authorization to Disclose Financial 

Records, VA Form 27–4718a—166. 

Estimated Average Burden per 

Respondent: 

a. Annual-Final Report and Account, 

VA Form 21–4706—30 minutes. 

b. Federal Fiduciary’s Accounts, VA 

Form 21–4706b—27 minutes. 

c. Court Appointed Fiduciary’s 

Account, VA Form 21–4706c—30 

minutes. 

d. Account Book, VA Form 21–4718— 

21⁄2 hours. 

e. Certificate of Balance on Deposit 

and Authorization to Disclose Financial 

Records, VA Form 27–4718a—3 

minutes. 

Frequency of Response: Annually. 

Estimated Number of Respondents: 

a. Annual-Final Report and Account, 

VA Form 21–4706—2,200. 

b. Federal Fiduciary’s Accounts, VA 

Form 21–4706b—14,000. 

c. Court Appointed Fiduciary’s 

Account, VA Form 21–4706c—4,000. 

d. Account Book, VA Form 21–4718— 

8,000. 

e. Certificate of Balance on Deposit 

and Authorization to Disclose Financial 

Records, VA Form 27–4718a—3,312. 

Dated: June 24, 2009. 

By direction of the Secretary. 

Denise McLamb, 

Program Analyst, Enterprise Records Service. 

[FR Doc. E9–15274 Filed 6–26–09; 8:45 am] 

BILLING CODE 8320–01–P 

DEPARTMENT OF VETERANS 

AFFAIRS 

[OMB Control No. 2900–0319] 

Proposed Information Collection 

(Fiduciary Agreement) Activity: 

Comment Request 

AGENCY: Veterans Benefits 

Administration, Department of Veterans 

Affairs. 

ACTION: Notice. 

SUMMARY: The Veterans Benefits 

Administration (VBA), Department of 

Veterans Affairs (VA), 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 for information 

needed to establish a legal contract 

between VA and a Federally appointed 

fiduciary. 

DATES: Written comments and 

recommendations on the proposed 

collection of information should be 

received on or before August 28, 2009. 

ADDRESSES: Submit written comments 

on the collection of information through 

Federal Docket Management System 

(FDMS) at http://www.Regulations.gov 

or to Nancy J. Kessinger, Veterans 

Benefits Administration (20M35), 

Department of Veterans Affairs, 810 

Vermont Avenue, NW., Washington, DC 

20420 or e-mail to 

nancy.kessinger@va.gov. Please refer to 

‘‘OMB Control No. 2900–0319’’ in any 

correspondence. During the comment 

period, comments may be viewed online 

through FDMS. 

FOR FURTHER INFORMATION CONTACT: 

Nancy J. Kessinger at (202) 461–9769 or 

FAX (202) 275–5947. 

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, VBA invites 

comments on: (1) Whether the proposed 

collection of information is necessary 

for the proper performance of VBA’s 

functions, including whether the 

information will have practical utility; 

(2) the accuracy of VBA’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: Fiduciary Agreement, VA Form 

21–4703. 

OMB Control Number: 2900–0319. 

Type of Review: Extension of a 

currently approved collection. 

Abstract: VA Form 21–4703 is a legal 

binding contract between VA and 

Federally appointed fiduciaries 

receiving VA funds on behalf of 

beneficiaries who were determined to be 

incompetent or under legal disability by 

reason of minority or court action. The 

form outlines the fiduciary’s 

responsibility regarding the use of VA 

funds. 

Affected Public: Individuals or 

households. 

Estimated Annual Burden: 1,467 

hours. 

Estimated Average Burden per 

Respondent: 5 minutes. 

Frequency of Response: One time. 

Estimated Number of Respondents: 

17,600. 

Dated: June 24, 2009. 

By direction of the Secretary. 

Denise McLamb, 

Program Analyst, Enterprise Records Service. 

[FR Doc. E9–15275 Filed 6–26–09; 8:45 am] 

BILLING CODE 8320–01–P 


sroberts on PROD1PC70 with NOTICES