[Federal Register Volume 82, Number 192 (Thursday, October 5, 2017)]
[Notices]
[Page 46614]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-21433]



[[Page 46614]]

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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-NEW]


Agency Information Collection Activity Under OMB Review: General 
Release for Medical Provider Information to the Department of Veterans 
Affairs (VA) and Authorization and Consent To Release Information to 
the Department of Veterans Affairs

AGENCY: Veterans Benefits Administration, Department of Veterans 
Affairs.

ACTION: Notice.

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SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995, 
this notice announces that the Veterans Benefits 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 it 
includes the actual data collection instrument.

DATES: Comments must be submitted on or before November 6, 2017.

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#9ef1f7ecffc1edebfcf3f7ededf7f1f0def1f3fcb0fbf1eeb0f9f1e8"><span class="__cf_email__" data-cfemail="6807011a09371b1d0a05011b1b0107062807050a460d0718460f071e">[email protected]</span></a>. Please refer to ``OMB Control No. 2900-
NEW'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor, Enterprise 
Records Service (005R1B), Department of Veterans Affairs, 811 Vermont 
Avenue NW., Washington, DC 20420, (202) 461-5870 or email 
<a href="/cdn-cgi/l/email-protection#ff9c86918b97969ed1979e8d899a86d28f8d86908dbf899ed1989089"><span class="__cf_email__" data-cfemail="ed8e94839985848cc3858c9f9b8894c09d9f94829fad9b8cc38a829b">[email protected]</span></a>. Please refer to ``OMB Control No. 2900-
NEW'' in any correspondence.

SUPPLEMENTARY INFORMATION: 

    Authority: 44 U.S.C. 3501-21.

    Title: General Release for Medical Provider Information to the 
Department of Veterans Affairs (VA) (VA Form 21-4142) and Authorization 
and Consent to Release Information to the Department of Veterans 
Affairs (VA Form 21-4142a).
    OMB Control Number: 2900-NEW.
    Type of Review: New collection.
    Abstract: VA Forms 21-4142 will be used to authorize the disclosure 
of information to the VA and 21-4142a will be used to gather the 
necessary information to request medical provider information to the 
VA.
    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 at 82 FR 125 on June 30, 2017, page 30004.
    Affected Public: Individuals or Households.
    Estimated Annual Burden: 11,033.
    Estimated Average Burden per Respondent: 5 minutes.
    Frequency of Response: One time.
    Estimated Number of Respondents: 132,400.

    By direction of the Secretary.
Cynthia Harvey-Pryor,
Department Clearance Officer, Office of Quality, Privacy and Risk, 
Department of Veterans Affairs.
[FR Doc. 2017-21433 Filed 10-4-17; 8:45 am]
 BILLING CODE 8320-01-P


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