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Agency Information Collection Activities Under OMB Review

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Information about this document as published in the Federal Register.

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Veterans Health Administration, Department of Veterans Affairs.




In compliance with the Paperwork Reduction Act (PRA) of 1995 (44 U.S.C., 3501 et seq.), this notice announces that the Veterans Health Administration (VHA), Department of Veterans Affairs, has submitted 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.


Comments must be submitted on or before September 20, 2001.

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Denise McLamb, Information Management Service (045A4), Department of Veterans Affairs, 810 Vermont Avenue, NW, Washington, DC 20420, (202) 273-8030 or FAX (202) 273-5981 or e-mail Please refer to “OMB Control No. 2900-0188.”

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a. Request to Submit Estimate, Form Letter 10-90.

b. Loan Follow-up Letter, Form Letter 10-426.

c. Veterans Application for Assistance in Acquiring Home Improvement and Structural Alterations, VA Form 10-0103.

d. Application for Adaptive Equipment Motor Vehicle, VA Form 10-1394.

e. Prosthetic Authorization for Items or Services, VA Form 10-2421.

f. Prosthetic Service Card Invoice, VA Form 10-2520.

g. Prescription and Authorization for Eyeglasses, VA Form 10-2914.

OMB Control Number: 2900-0188.

Type of Review: Extension of a currently approved collection.


a. Form Letter 10-90 is prepared by the VHA and issued to a contractor of the veteran's choice in order to solicit a price quote for a prosthetic device.

b. Form Letter 10-426 is used to inventory prosthetic devices loaned to eligible veterans. The form letter inventories the loaned items and solicits information from the beneficiary to determine the current status, the need to replace, extend the loan period or terminate the loaned items.

c. VA Form 10-0103 is used to determine eligibility/entitlement and reimbursement of individual claims for home improvement and structural alterations.

d. VA Form 10-1394 is used to determine eligibility/entitlement and reimbursement of individual claims for automotive adaptive equipment.

e. VA Form 10-2421 is used for the direct procurement of new prosthetic appliances and/or services and standardizes the direct procurement authorization process. The form eliminates the need for separate purchase orders, expedites patient treatment and improves the delivery of prosthetic services.

f. VA Form 10-2520 is used by the commercial vendors after completing repairs authorized for veterans by their Prosthetic Service Card to request payment by VA. The form standardizes repair/treatment invoices for prosthetic services rendered and standardizes the verification of these invoices. The veteran certifies that the repairs were necessary and satisfactory. This form is furnished to vendors upon request.

g. VA Form 10-2914 is used as a combination prescription, authorization and invoice. It allows veterans to purchase their eyeglasses directly. If the form is not used, the provisions of providing eyeglasses to eligible veterans may be delayed.

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 May 31, 2001, at pages 29632-29633.

Affected Public: Business or other for profit and Individuals or households.

Estimated Total Annual Burden: 37,079 hours.

a. Form Letter 10-90—1,875.

b. Form Letter 10-426—242.

c. VA Form 10-0103—583.

d. VA Form 10-1394—2,711.

e. VA Form 10-2421—16,667.

f. VA Form 10-2520—3,334.

g. VA Form 10-2914—11,667.

Estimated Average Burden Per Respondent:

a. Form Letter 10-90—5 minutes.

b. Form Letter 10-426—1 minute.

c. VA Form 10-0103—5 minutes.

d. VA Form 10-1394—15 minutes.

e. VA Form 10-2421—4 minutes.

f. VA Form 10-2520—5 minutes.

g. VA Form 10-2914—4 minutes.

Frequency of Response: On occasion.

Estimated Number of Respondents: 519,844.

a. Form Letter 10-90—22,500.

b. Form Letter 10-426—14,500.

c. VA Form 10-0103—7,000.

d. VA Form 10-1394—10,844.

e. VA Form 10-2421—250,000.

f. VA Form 10-2520—40,000.

g. VA Form 10-2914—175,000.

Send comments and recommendations concerning any aspect of the information collection 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. 2900-0188” in any correspondence.

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Dated: August 10, 2001.

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By direction of the Secretary.

Donald L. Neilson,

Director, Information Management Service.

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[FR Doc. 01-20989 Filed 8-20-01; 8:45 am]