This PDF is the current document as it appeared on Public Inspection on 06/29/2017 at 08:45 am.
Veterans Benefits Administration, Department of Veterans Affairs.
Veterans Benefits Administration, 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.
Written comments and recommendations on the proposed collection of information should be received on or before August 29, 2017.
Submit written comments on the collection of information through Federal Docket Management System (FDMS) at www.Regulations.gov or to Nancy J. Kessinger, Veterans Benefits Administration (20M33), Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420 or email to firstname.lastname@example.org. Please refer to “OMB Control No. 2900—NEW” in any correspondence. During the comment period, comments may be viewed online through FDMS.Start Further Info
FOR FURTHER INFORMATION CONTACT:
Cynthia Harvey-Pryor at (202) 461-5870.End Further Info End Preamble Start Supplemental Information
Under the PRA of 1995, 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, VBA invites comments on: (1) Whether the proposed collection of information is necessary for the proper performance of VBA's functions, including whether the information will have practical utility; (2) the accuracy of VBA'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: General Release for Medical Provider Information to the Department of Veterans Affairs (VA) (VA Form 21-4142) and Authorization and Consent to Release Information to the Department of Veterans Affairs (VA Form 21-4142a).
OMB Control Number: 2900—NEW.
Type of Review: New collection.
Abstract: VA Forms 21-4142 will be used to authorize the disclosure of information to the VA and 21-4142a will be used to gather the necessary information to request medical provider information to the VA.
Affected Public: Individuals and households.
Estimated Annual Burden: 11,033 hours.
Estimated Average Burden per Respondent: 5 minutes.
Frequency of Response: On occasion.
Estimated Number of Respondents: 132,400.Start Signature
By direction of the Secretary.
Department Clearance Officer, Office of Privacy and Records Management, Department of Veterans Affairs.
[FR Doc. 2017-13731 Filed 6-29-17; 8:45 am]
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