Agency Information Collection Activities; Proposals, Submissions, and Approvals:
Federal Register Volume 76, Number 118 (Monday, June 20, 2011)
Notices
Pages 35950-35951
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
FR Doc No: 2011-15202
DEPARTMENT OF VETERANS AFFAIRS
OMB Control No. 2900-New (DBQs--Group 3)
Agency Information Collection (Disability Benefits
Questionnaires--Group 3) Activity Under OMB Review
AGENCY: Veterans Benefits Administration, Department of Veterans
Affairs.
ACTION: Notice.
SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995
(44 U.S.C. 3501-3521), this notice announces that the Veterans Benefits
Administration (VBA), 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; it includes the actual data collection instrument.
DATES: Comments must be submitted on or before July 20, 2011.
ADDRESSES: Submit written comments on the collection of information through http://www.Regulations.gov or to VA's OMB Desk Officer, OMB
Human Resources and Housing Branch, New Executive Office Building, Room 10235, Washington, DC 20503 (202) 395-7316. Please refer to ``OMB
Control No. 2900-New (DBQs--Group 3)'' in any correspondence.
FOR FURTHER INFORMATION CONTACT: Denise McLamb, Enterprise Records
Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue,
NW., Washington, DC 20420, (202) 461-7485, FAX (202) 461-0966 or e-mail denise.mclamb@va.gov. Please refer to ``OMB Control No. 2900--New
(DBQs--Group 3).''
SUPPLEMENTARY INFORMATION:
Titles: a. Central Nervous System and Neuromusculo Diseases, Disability
Benefits Questionnaire, VA Form 21-0960C-5. b. Headaches (Including Migraine Headaches), Disability Benefits
Questionnaire, VA Form 21-0960C-8. c. Multiple Sclerosis (MS), Disability Benefits Questionnaire, VA
Form 21-0960C-9. d. Esophageal Disorders (Including GERD), Disability Benefits
Questionnaire, VA Form 21-0960G-1. e. Gallbladder and Pancreas Conditions, Disability Benefits
Questionnaire, VA Form 21-0960G-2. f. Intestinal Disorders (Other Than Surgical or Infectious)
(Including
Page 35951
Irritable Bowel Syndrome, Crohn's Disease, Ulcerative Colitis, and
Diverticulitis) Disability Benefits Questionnaire, VA Form 21-0960G-3. g. Intestines Surgical and/or Infectious Intestinal Disorders
(Bowel Resection, Colostomy, Ileostomy, Bacterial and Parasitic
Infections) Disability Benefits Questionnaire, VA Form 21-0960G-4. h. Hepatitis, Cirrhosis and Other Liver Conditions, Disability
Benefits Questionnaire, VA Form 21-0960G-5. i. Peritoneal Adhesions Disability Benefits Questionnaire, VA Form 21-0960G-6. j. Stomach and Duodenal Conditions (Not Including GERD or
Esophageal Disorders) Disability Benefits Questionnaire, VA Form 21- 0960G-7. k. Rectum and Anus Disability Benefits Questionnaire, VA Form 21- 0960H-2. l. Breast Conditions and Disorders Disability Benefits
Questionnaire, VA Form 21-0960K-1. m. Gynecological Conditions Disability Benefits Questionnaire, VA
Form 21-0960K-2. n. Sleep Apnea Disability Benefits Questionnaire, VA Form 21-0960L- 2. o. Arthritis Disability Benefits Questionnaire, VA Form 21-0960M-3. p. Osteomyelitis Disability Benefits Questionnaire, VA Form 21- 0960M-11. q. Ear Conditions (Including Vestibular and Infectious) Disability
Benefits Questionnaire, VA Form 21-0960N-1.
OMB Control Number: 2900-New (DBQs--Group 3).
Type of Review: New collection.
Abstract: Data collected on VA Form 21-0960 series will be used obtain information from claimants treating physician that is necessary to adjudicate a claim for disability benefits.
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 April 15, 2011, at pages 21429-21430.
Affected Public: Individuals or households.
Estimated Annual Burden: a. VA Form 21-0960C-5--5,000. b. VA Form 21-0960C-8--3,750. c. VA Form 21-0960C-9--7,500. d. VA Form 21-0960G-1--10,000. e. VA Form 21-0960G-2--1,250. f. VA Form 21-0960G-3--1,250. g. VA Form 21-0960G-4--1,250. h. VA Form 21-0960G-5--5,000. i. VA Form 21-0960G-6--1,250. j. VA Form 21-0960G-7--2,500. k. VA Form 21-0960H-2--2,500. l. VA Form 21-0960K-1--7,500. m. VA Form 21-0960K-2--10,000. n. VA Form 21-0960L-2--1,250. o. VA Form 21-0960M-3--25,000. p. VA Form 21-0960M-11--10,000. q. VA Form 21-0960N-1--6,250.
Estimated Average Burden per Respondent: a. VA Form 21-0960C-5--30 minutes. b. VA Form 21-0960C-8--15 minutes. c. VA Form 21-0960C-9--45 minutes. d. VA Form 21-0960G-1--15 minutes. e. VA Form 21-0960G-2--15 minutes. f. VA Form 21-0960G-3--15 minutes. g. VA Form 21-0960G-4--15 minutes. h. VA Form 21-0960G-5--30 minutes. i. VA Form 21-0960G-6--15 minutes. j. VA Form 21-0960G-7--15 minutes. k. VA Form 21-0960H-2--15 minutes. l. VA Form 21-0960K-1--15 minutes. m. VA Form 21-0960K-2--30 minutes. n. VA Form 21-0960L-2--15 minutes. o. VA Form 21-0960M-3--15 minutes. p. VA Form 21-0960M-11--15 minutes. q. VA Form 21-0960N-1--15 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents: a. VA Form 21-0960C-5--10,000. b. VA Form 21-0960C-8--15,000. c. VA Form 21-0960C-9--10,000. d. VA Form 21-0960G-1--40,000. e. VA Form 21-0960G-2--5,000. f. VA Form 21-0960G-3--5,000. g. VA Form 21-0960G-4--5,000. h. VA Form 21-0960G-5--10,000. i. VA Form 21-0960G-6--5,000. j. VA Form 21-0960G-7--10,000. k. VA Form 21-0960H-2--10,000. l. VA Form 21-0960K-1--30,000. m. VA Form 21-0960K-2--20,000. n. VA Form 21-0960L2--5,000. o. VA Form 21-0960M-3--100,000. p. VA Form 21-0960M-11--40,000. q. VA Form 21-0960N-1--25,000.
By direction of the Secretary.
Dated: June 15, 2011.
Denise McLamb,
Program Analyst, Enterprise Records Service.
FR Doc. 2011-15202 Filed 6-17-11; 8:45 am
BILLING CODE 8320-01-P
