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Proposed Information Collection Activity: Proposed Collection; Comment Request

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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.




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 extension 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 reimburse veterans insured by United Services Automobile Association (USAA) and Hartford Life Insurance for co-payments paid to VA for their medical care.


Written comments and recommendations on the proposed collection of information should be received on or before June 2, 2003.


Submit written comments on the collection of information to Ann Bickoff, Veterans Health Administration (193B1), Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420 or e-mail Please refer to “OMB Control No. 2900-0642” in any correspondence.

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Ann Bickoff at (202) 273-8310.

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Under the PRA of 1995 (Pub. L. 104-13; 44 U.S.C. 3501-3520), 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: VA Copayment Refund—USAA/Hartford Claim Form, VA Form 10-0406.

OMB Control Number: 2900-0642.

Type of Review: Extension of a currently approved collection.

Abstract: VA Form 10-0406 will be used to reimburse veterans insured by USAA/Hartford Life Insurance for co-payments they paid to VA for medical care from January 1, 1995, through December 31, 2001. Such insured veterans will have a one year time period from the initial notification date on a first-come-first-served basis, to file claim with VA for refund of their co-payments. The information collected will be used to determine the validity of such claims.

Affected Public: Individuals or households.

Estimated Total Annual Burden: 12,000 hours.

Estimated Average Burden Per Respondent: 30 minutes.

Frequency of Response: One time.

Estimated Number of Respondents: 24,000.

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Dated: March 25, 2003.

By direction of the Secretary.

Martin L. Hill,

Acting Director, Records Management Service.

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[FR Doc. 03-8157 Filed 4-2-03; 8:45 am]