2019 09203

Transcript

1 This document is scheduled to be published in the Federal Register on 05/06/2019 and available online at https://federalregister.gov/d/2019-09203 govinfo.gov , and on DEPARTMENT OF VETERANS AFFAIRS 0781 ] [OMB Control No. - 2900 Disability Benefit Questionnaire (Group 4) Agency Information Collection s Activity: Veterans Benefits Administration AGENCY: , Department of Veterans Affairs ACTION: Notice Veterans , Department of Veterans Affairs (VA), is SUMMARY: Benefits Administration 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 a DATES: nd recommendations on the proposed collection of [ information should be received on or before INSERT DATE 60 DAYS AFTER DATE . ] E FEDERAL REGISTER OF PUBLICATION IN TH ADDRESSES: Submit written comments on the collection of information through ) at www.Regulations.gov or to Nancy J. Federal Docket Management System (FDMS Kessinger, Veterans Benefits Administration (20M33), Department of Veterans Affairs, - 810 Vermont Avenue, NW, Washington, DC 20420 or e mail to Please refer to "OM " in any 2900 - 0781 [email protected] B Control No. correspondence. During the comment period, comments may be viewed online through FDMS. 1

2 FOR FURTHER INFORMATION CONTACT: Danny S. Green at (202) 421 - 1354 . RY INFORMATION: SUPPLEMENTA 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 t he 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. Authority : Pu blic Law 104 - 13; 44 U.S.C. 3501 – 3521 . Title : Disability Benefits Questionnaire (Group 4). : 2900 OMB Control Number 0781. - : Extension of a currently approved collection. Type of Review : Abstract The VA Form 21 - 0960 series will be used to gather necessary information from a claimant’s treating physician regarding the results of medical examinations. VA t that is necessary to adjudicate the will gather medical information related to the claiman claim for VA disability benefits. The Disability Benefits Questionnaire title will include the name of the specific disability for which it will gather information. The Disability Benefit 2

3 Questionnaire Group 4 - 0960C - 3, Cranial includes the following forms: VA Form 21 , will g Nerve Conditions Disability Benefits Questionnaire ather information related to the VA Form 21 - 0960C - claimant’s diagnosis of any cranial nerve condition; , Narcolepsy 6 Disability Benefits Que stionnaire , will gather information related to the claimant’s diagnosis of narcolepsy; VA Form 21 - 0960C - 7 , Fibromyalgia Disability Benefits Questionnaire , will gather information related to the claimant’s diagnosis of fibromyalgia; , 21 0960C - VA Form - Sei zure Disorders (Epilepsy) Disability Benefits Questionnaire , 11 will gather information related to the claimant’s diagnosis of any seizure disorder including epilepsy; VA Form 21 - 0960D - 1 , Oral and Dental Conditions Including Mouth, Lips and Tongue (Other than Temporomandibular Joint Conditions) Disability Benefits Questionnaire , will gather information related to the claimant’s diagnosis of any oral or , Endocrine Diseases (Other than Thyroid, 2 dental conditions; VA Form 21 - 0960E - Parathyroid, or Diabetes Melli , will gather tus) Disability Benefits Questionnaire information related to the claimant’s diagnosis of any endocrine disease including cushings and acromegaly , however it exclud es diabetes; VA Form 21 - 0960E - 3 , Thyroid and Parathyroid Conditions Disability Benefits Questionnaire , will gather information related to the claimant’s diagnosis of any thyroid or parathyroid condition; VA Form 21 - 1 0960H - , Hernias (Including Abdominal, Inguinal, and Femoral hernias) Disability Benefits Questionnaire , will gather inf ormation related to the claimant’s diagnosis of 2 VA Form 21 - 0960I abdominal, inguinal, or femoral hernias; , HIV - Related Illness - Disability Benefits Questionnaire , will gather information related to the claimant’s - diagnosis of any HIV related illness; VA F orm 21 - 0960I - 3 , Infectious Diseases Other - Related Illness, Chronic Fatigue Syndrome, and Tuberculosis Disability Than HIV 3

4 Benefits Questionnaire , will gather information related to the claimant’s diagnosis of any 21 0960I - 4 , infectious diseases; VA Form - Systemic Lupus Erythematosus (SLE) and other Autoimmune Diseases Disability Benefits Questionnaire , will gather information related to the claimant’s diagnosis of lupus or other immune disorders; VA Form 21 - 0960I - 5 , Nutritional Deficiencies Disability Bene fits Questionnaire , will gather information related to the claimant’s diagnosis of nutritional deficiencies; VA Form 21 - - 4 , 0960J Urinary Tract (including Bladder & Urethra) Conditions (excluding Male Reproductive System) Disability Benefits Questionnaire , will gather information related to the claimant’s diagnosis of any urinary tract or bladder condition; VA Form 21 - 0960L - 1 , Respiratory Conditions (Other than Tuberculosis & Sleep Apnea) Disability Benefits Questionnaire , will gather information related to the claimant’s diagnosis of any Loss of Sense of Smell and/or Taste - respiratory condition; VA Form 21 , 0960N - 3 Disability Benefits Questionnaire , will gather information related to the claimant’s loss of VA Form 21 - 0960N - sense of smell and taste; , Sinusitis/ Rhinitis and Other Conditions 4 of the Nose, Throat, Larynx, and Pharynx Disability Benefits Questionnaire , will gather information related to the claimant’s diagnosis of sinusitis/rhinitis or other diseases of the nose, throat, larynx, or pharynx ; VA Form 21 - 0960Q - 1 , Chronic Fatigue Syndrome Disability Benefits Questionnaire, will gather information related to the claimant’s diagnosis of chronic fatigue syndrome. Affected Public : Individuals and households . Estimated Annual Burden : 53,750 hours . Estimated Average Burden Per Respondent : 18.5 minutes per form (17 forms) . . time Frequency of Response : one - 4

5 160,000 . Estimated Number of Respondents: By direction of the Secretary: Danny S. Green VA Interim Clearance Officer Quality k Office of s , Performance and R i Department of Veterans Affairs 01 BILLING CODE 8320 - - P - 09203 Filed: 5/3/2019 8:45 am; Publication Date: 5/6/2019] [FR Doc. 2019 5

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