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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 revision 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 healthcare providers for medical services provided to veterans with service-connected disabilities living or traveling overseas.


Written comments and recommendations on the proposed collection of information should be received on or before July 31, 2006.

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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. 2900-0648” in any correspondence.

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Ann Bickoff at (202) 273-8310.

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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.

Title and Form Number: Foreign Medical Program, VA Form 10-7959f-1 and 10-7959f-2.

OMB Control Number: 2900-0648.

Type of Review: Revision of a currently approved collection.


a. Veterans with service connected disabilities living or traveling overseas complete VA Form 10-7959f-1 to enroll in the Foreign Medical Program.

b. Healthcare providers complete VA Form 10-7959f-2 to submit claims for payments or reimbursement of expenses relating to veterans living or traveling overseas (except for Canada and the Philippines) with service-connected disability. VA accepts provider generated billing statement, Uniform Billing-Forms (UB) 92, and Medicare Health Insurance Claims Form, HCFA 1500 for payments or reimbursements.

Affected Public: Individuals or households, Business or other for profit, and Not for profit institutions.

Estimated Total Annual Burden: 3,763 hours.

a. Foreign Medical Program, VA Form 10-7959f-1—111 hours.

b. Claim Cover Sheet, VA Form 10-7959-2—3,652 hours.

Estimated Average Burden Per Respondent:

a. Foreign Medical Program, VA Form 10-7959f-1—4 minutes.

b. Claim Cover Sheet, VA Form 10-7959-2—11 minutes.

Frequency of Response: On occasion.

Estimated Number of Respondents: 3320.

a. Foreign Medical Program, VA Form 10-7959f-1—1,660.

b. Claim Cover Sheet, VA Form 10-7959f-2—1,660.

Estimated Total Annual Responses: 21,580.

a. Foreign Medical Program, VA Form 10-7959-1—1,660.

b. Claim Cover Sheet, VA Form 10-7959-2—19,920.

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Dated: May 17, 2006.

By direction of the Secretary.

Denise McLamb,

Program Analyst, Records Management Service.

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[FR Doc. E6-8413 Filed 5-31-06; 8:45 am]