Agency Information Collection Activities Under OMB Review

DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0205]

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 January 21, 2000.

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) 273-8030

or FAX (202) 273-5981. Please refer to ``OMB Control No. 2900-0205.''

SUPPLEMENTARY INFORMATION:

Titles and Form Number:

a. VA Form 10-2850, Application for Physicians, Dentists,

Podiatrists and Optometrists.

b. VA Form 10-2850a, Application for Nurses and Nurse Anesthetists.

c. VA Form 10-2850b, Application for Residents.

d. VA Form 10-2850c, Application for Associated Health Occupations.

e. VA Form FL 10-341a, Appraisal of Applicant.

OMB Control Number: 2900-0205

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

approved collection for which approval has expired.

Abstract: VA Forms 10-2850 and 10-2850a through c are applications

designed specifically to elicit appropriate information about each

candidate's qualifications for employment with VA. VHA officials use

the information to evaluate education, professional experience and

credentials and to determine suitability and grade level of

applications of physicians, dentists, podiatrists, optometrists, nurses

and nurse anesthetists, residents, and associated health occupations,

and appraisal of applicants. The forms require disclosure of details

about all licenses ever held, Drug Enforcement Administration

certification, board certification, clinical privileges, revoked

certification or registrations, liability insurance history, and

involvement in malpractice proceedings. Form Letter 10-341a is a pre

employment reference form used to elicit information concerning the

prior education and/or performance of the Title 38 applicant.

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 September 20, 1999, at pages 50868-50869.

[[Page 72147]]

Affected Public: Individuals or Households, Business or other for-

profit, Not-for-profit institutions, Federal Government, State, Local

or Tribal Government.

Estimated Annual Burden: 68,610 hours.

a. VA Form 10-2850, Application for Physicians, Dentists,

Podiatrists and Optometrists--6,450 hours.

b. VA Form 10-2850a, Application for Nurses and Nurse

Anesthetists--25,800 hours.

c. VA Form 10-2850b, Application for Residents--13,760 hours.

d. VA Form 10-2850c, Application for Associated Health

Occupations--8,600 hours.

e. VA Form FL 10-341a, Appraisal of Applicant--14,000 hours.

Estimated Average Burden Per Respondent: 27 minutes.

a. VA Form 10-2850, Application for Physicians, Dentists,

Podiatrists and Optometrists--30 minutes.

b. VA Form 10-2850a, Application for Nurses and Nurse

Anesthetists--30 minutes.

c. VA Form 10-2850b, Application for Residents--30 minutes.

d. VA Form 10-2850c, Application for Associated Health

Occupations--30 minutes.

e. VA Form FL 10-341a, Appraisal of Applicant--20 minutes.

Frequency of Response: On occasion.

Estimated Number of Respondents: 151,220.

a. VA Form 10-2850, Application for Physicians, Dentists,

Podiatrists and Optometrists--12,900.

b. VA Form 10-2850a, Application for Nurses and Nurse

Anesthetists--51,600.

c. VA Form 10-2850b, Application for Residents--27,520.

d. VA Form 10-2850c, Application for Associated Health

Occupations--17,200.

e. VA Form FL 10-341a, Appraisal of Applicant--42,000.

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. 2900-0205'' in any correspondence.

Dated: December 3, 1999.

By direction of the Secretary.

Sandra McIntyre,

Program Analyst, Information Management Service.

[FR Doc. 99-33253 Filed 12-22-99; 8:45 am]

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