Agency Information Collection Activities Under OMB Review

DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0080]

Agency Information Collection Activities Under OMB Review

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: 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.

DATES: Comments must be submitted on or before May 11, 1998.

FOR FURTHER INFORMATION OR A COPY OF THE SUBMISSION CONTACT: Ron

Taylor, Information Management Service (045A4), Department of Veterans

Affairs, 810 Vermont Avenue, NW, Washington, DC 20420, (202) 273-8015

or FAX (202) 273-5981. Please refer to ``OMB Control No. 2900-0080.''

SUPPLEMENTARY INFORMATION:

Title: Claim for Payment of Cost of Unauthorized Medical Service,

Authority and Invoice for Travel by Ambulance or Other Hired Vehicle,

and Authorization and Invoice for Medical and Hospital Services.

Form Numbers:

a. VA Form 10-583, Claim for Payment of Cost of Unauthorized

Medical Service.

b. VA Form 10-2511, Authority and Invoice for Travel by Ambulance

or Other Hired Vehicle.

c. VA Form 10-7078, Authorization and Invoice for Medical and

Hospital Services.

OMB Control Number: 2900-0080.

Type of Review: Reinstatement, without change, of a previously

approved collection for which approval has expired.

Abstract:

a. VA Form 10-583 is used by administrative personnel in VA medical

facilities of fee jurisdiction to collect information for determining

legal and medical eligibility of applicants for payment or

reimbursement of the costs of unauthorized medical services obtained by

a veteran. The form is completed by the applicant as an official claim

for such benefits and by VA officials to certify the authorized payment

or reimbursement and to authorize such payment. If the collection of

information was not carried out, VA's ability to provide reimbursement

or payment for these costs would be negated.

b. Administrative personnel in VA medical facilities to authorize

expenditures from the beneficiary trust account use VA Form 10-2511. It

is also used to process payment for ambulance or other hired vehicular

forms of transportation to eligible veterans to and from VA health care

facilities for examination, treatment or care. If the collection of

information were not conducted payment to vendors for services rendered

would not be possible.

c. VA Form 10-7078 is used by administrative personnel in VA

medical facilities to authorize expenditures from the medical care

account and process payment of medical and hospital services provided

by other than Federal health providers to VA beneficiaries. Without the

use of this form would complicate management and record keeping of

expenditures for medical care provided at VA expense by the private

sector.

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 January 14, 1998 at page 2302.

Affected Public: Business or other for-profit--Individuals or

households--Not-for-profit institutions--State, Local or Tribal

Government.

Estimated Total Annual Burden: 29,671 hours.

a. VA Form 10-583--17,188 hours.

b. VA Form 10-2511--4,083 hours.

c. VA Form 10-7078--8,400 hours.

Estimated Average Burden Per Respondent:

a. VA Form 10-583--15 minutes.

b. VA Form 10-2511--2 minutes.

c. VA Form 10-7078--2 minutes.

Frequency of Response: On occasion.

Estimated Number of Respondents: 443,250.

a. VA Form 10-2421--68,750.

b. VA Form 10-2520--122,500.

c. VA Form 10-2914--252,000.

Send comments and recommendations concerning any aspect of the

information collection to VA's OMB Desk Officer, Allison Eydt, OMB

Human Resources and Housing Branch, New Executive Office Building, Room

10235, Washington, DC 20503 (202) 395-4650. Please refer to ``OMB

Control No. 2900-0080'' in any correspondence.

Dated: March 16, 1998.

By direction of the Secretary.

Donald L. Neilson,

Director, Information Management Service.

[FR Doc. 98-9318 Filed 4-8-98; 8:45 am]

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