Agency Information Collection Activities Under OMB Review

DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-NEW]

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 December 23, 1999.

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

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

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

[[Page 65763]]

8030 or FAX (202) 273-5981. Please refer to ``OMB Control No. 2900-

NEW.''

SUPPLEMENTARY INFORMATION:

Title: Census of Enrollment Status and Health of Veterans.

a. Veterans Short Form 36, VA Form 10-21034.

b. Core Assessments, VA Form 10-21034a.

c. Diet/Physical Activity Module, VA Form 10-21034b.

d. Satisfaction Module, VA Form 10-21034c.

e. Smoking/Alcohol Module, VA Form 10-21034d.

f. Social Support Module, VA Form 10-21034e.

g. Utilization/Insurance Module, VA Form 10-21034f.

h. Census of Enrollment Status, VA Form 10-21034g.

OMB Control Number: 2900-NEW.

Type of Review: New collection.

Abstract: The information provided on the Census of Health of

Veterans form is to be foremost for clinical purposes by doctors and

health care providers in the routine care of the patient.

Administrators and policy makers will use the information to

characterize individual physician practices, hospitals and Vertically

Integrated Services Networks. The information on Census of Enrollment

form is used to develop the characteristics of the new VA enrolled

population.

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 August 10, 1999 at pages 43423-43424.

Affected Public: Individuals or households.

Estimated Annual Burden: 754,050 hours.

a. Veterans Short Form 36, VA Form 10-21034--300,000 hours.

b. Core Assessments, VA Form 10-21034a--300,000 hours.

c. Diet/Physical Activity Module, VA Form 10-21034b--25,000 hours.

d. Satisfaction Module, VA Form 10-21034c--25,000 hours.

e. Smoking/Alcohol Module, VA Form 10-21034d--25,000 hours.

f. Social Support Module, VA Form 10-21034e--25,000 hours.

g. Utilization/Insurance Module, VA Form 10-21034f--25,000 hours.

h. Census of Enrollment Status--4,050 hours.

Estimated Average Burden Per Respondent--24 minutes.

a. Census of Health of Veterans--15 minutes.

b. Census of Enrollment Status--9 minutes.

Frequency of Response: Generally one time.

Estimated Number of Respondents--3,027,000.

a. Veterans Short Form 36, VA Form 10-21034--1,000,000.

b. Core Assessments, VA Form 10-21034a--1,000,000.

c. Diet/Physical Activity Module, VA Form 10-21034b--200,000.

d. Satisfaction Module, VA Form 10-21034c--200,000.

e. Smoking/Alcohol Module, VA Form 10-21034d--200,000.

f. Social Support Module, VA Form 10-21034e--200,000.

g. Utilization/Insurance Module, VA Form 10-21034f--200,000.

h. Census of Enrollment Status--27,000.

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-NEW'' in any correspondence.

Dated: November 1, 1999.

By direction of the Secretary.

Sandra S. McIntyre,

Program Analyst, Information Management Service.

[FR Doc. 99-30470 Filed 11-22-99; 8:45 am]

BILLING CODE 8320-01-P