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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), Department of Veterans Affairs (VA), 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 for information needed to determine non-Federal nursing home or the residential care home qualification for providing care to veteran patients.


Written comments and recommendations on the proposed collection of information should be received on or before January 20, 2004.


Submit written comments on the collection of information to Ann W. Bickoff, Veterans Health Administration (193B1), Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420. Please refer to “OMB Control No. 2900-0616” in any correspondence.

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Ann W. Bickoff (202) 273-8310 or FAX (202) 273-9381.

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Under the PRA of 1995 (Public Law 104-13; 44 U.S.C. 3501-3521), 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.


a. Application for Furnishing Nursing Home Care to Beneficiaries of Veterans Affairs, VA Form 10-1170.

b. Residential Care Home Program—Sponsor Application, VA Form 10-2407.

OMB Control Number: 2900-0616.

Type of Review: Extension of a currently approved collection.

Abstract: Start Printed Page 65117

a. VA Form 10-1170 is an application used by nursing homes wishing to provide nursing home care to veterans who receive VA benefits. It gives the nursing home the opportunity to describe the building and its capacity, staffing, structure and programming.

b. VA Form 10-2407 is an application used by a residential care facility or home that wishes to provide residential home care to veterans. It serves as the agreement between VA and the residential care home that the home will submit to an initial inspection and comply with VA requirements for residential care.

Affected Public: Business or other for-profit, Not-for-profit institutions, and State, Local or Tribal Government.

Estimated Annual Burden:

a. VA Form 10-1170—167 hours.

b. VA Form 10-2407—83 hours.

Estimated Average Burden Per Respondent:

a. VA Form 10-1170—20 minutes.

b. VA Form 10-2407—5 minutes.

Frequency of Response: One time.

Estimated Number of Respondents:

a. VA Form 10-1170—500.

b. VA Form 10-2407—1,000.

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Dated: November 5, 2003.

By direction of the Secretary.

Jacqueline Parks,

IT Specialist, Records Management Service.

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[FR Doc. 03-28679 Filed 11-17-03; 8:45 am]