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 19, 2003.Start Further Info
FOR FURTHER INFORMATION OR A COPY OF THE SUBMISSION CONTACT:
Denise McLamb, Records Management Service (005E3), Department of Veterans Affairs, 810 Vermont Avenue, NW, Washington, DC 20420, (202) 273-8030, FAX (202) 273-5981 or e-mail to: firstname.lastname@example.org. Please refer to “OMB Control No. 2900-0642.”
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. 2900-0642” in any correspondence.End Further Info End Preamble Start Supplemental Information
Title: VA Copayment Refund—USAA/Hartford Claim Form, VA Form 10-0406. Start Printed Page 50218
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.
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 3, 2003, at page 16349.
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.Start Signature
Dated: August 8, 2003.
By direction of the Secretary.
IT Specialist, Records Management Service.
[FR Doc. 03-21231 Filed 8-19-03; 8:45 am]
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