Federal Register / Vol. 76, No. 34 / Friday, February 18, 2011 / Notices 9581 

Recovery Act establishes 100 percent 

Federal financial participation (FFP) as 

reimbursement to States for making 

incentive payments to providers for 

meaningful use of certified electronic 

health record technology and 90 percent 

FFP for administering these payments. 

Additionally, States are required to 

conduct oversight of this program and 

ensure no duplicate payments; thus, 

CMS is requiring States to submit 

information to CMS for prior approval 

before drawing down funding. These 

documents, if States choose to 

implement these flexibilities, will 

require a collection of information to 

effectuate these changes. 

The State Medicaid agencies will 

complete the templates. CMS will 

review the information to determine if 

the State has met all of the requirements 

of the Recovery Act provisions the 

States choose to implement. If the 

requirements are met, CMS will approve 

the amendments giving the State the 

authority to implement their Health 

Information Technology (HIT) strategy 

and implementation plans. For a State 

to receive Medicaid Title XIX funding, 

there must be an approved State 

Medicaid HIT Plan, Planning Advance 

Planning Document and 

Implementation Advance Planning 

Document; Form Number: CMS–10292 

(OMB#: 0938–1088); Frequency: Yearly, 

Once, Occasionally; Affected Public: 

State, Local, or Tribal Governments; 

Number of Respondents: 56; Total 

Annual Responses: 56; Total Annual 

Hours: 56. (For policy questions 

regarding this collection contact Sherry 

Armstead at 410–786–4342. For all 

other issues call 410–786–1326.) 

8. Type of Information Collection 

Request: Extension without change of a 

currently approved collection; Title of 

Information Collection: Provider 

Enrollment, Chain and Ownership 

System (PECOS) Security Consent Form; 

Use: The primary function of the 

Medicare enrollment application is to 

obtain information about the provider or 

supplier and whether the provider or 

supplier meets Federal and/or State 

qualifications to participate in the 

Medicare program. In addition, the 

Medicare enrollment application gathers 

information regarding the provider or 

supplier’s practice location, the identity 

of the owners of the enrolling 

organization, and information necessary 

to establish the correct claims payment. 

In establishing a Web based application 

process, we allow providers and 

suppliers the ability to enroll in the 

Medicare program via the Internet. For 

these applicants, no security consent 

form is needed to enroll or make a 

change in their Medicare enrollment 

information. These applicants receive 

complete access to their own 

enrollments through Internet-based 

Provider Enrollment, Chain and 

Ownership System (PECOS). 

In order to allow a provider or 

supplier to delegate the Medicare 

credentialing process to another 

individual or organization, it is 

necessary to establish a Security 

Consent Form for those providers and 

suppliers who choose to have another 

individual or organization access their 

enrollment information and complete 

enrollments on their behalf. These users 

could consist of administrative staff, 

independent contractors, or 

credentialing departments and are 

represented as Employer Organizations. 

Employer Organizations and its 

members must request access to 

enrollment data through a Security 

Consent Form. The security consent 

form replicates business service 

agreements between Medicare 

applicants and organizations providing 

enrollment services. 

We are proposing two different 

versions of the Security Consent Form. 

The form, once signed, mailed and 

approved, grants an employer 

organization or its member’s access to 

all current and future enrollment data 

for the Medicare provider. Form 

Number: CMS–10220 (OMB#: 0938– 

1035); Frequency: Occassionally; 

Affected Public: State, Local, or Tribal 

Governments; Number of Respondents: 

197,500; Total Annual Responses: 

197,500; Total Annual Hours: 49,375. 

(For policy questions regarding this 

collection contact Alisha Banks at 410– 

786–0671. For all other issues call 410– 

786–1326.) 

To obtain copies of the supporting 

statement and any related forms for the 

proposed paperwork collections 

referenced above, access CMS Web Site 

address at http://www.cms.hhs.gov/ 

PaperworkReductionActof1995, or 

E-mail your request, including your 

address, phone number, OMB number, 

and CMS document identifier, to 

Paperwork@cms.hhs.gov, or call the 

Reports Clearance Office on (410) 786– 

1326. 

To be assured consideration, 

comments and recommendations for the 

proposed information collections must 

be received by the OMB desk officer at 

the address below, no later than 5 p.m. 

on March 21, 2011. 

OMB, Office of Information and 

Regulatory Affairs, Attention: CMS Desk 

Officer, Fax Number: (202) 395–6974, 

E-mail: OIRA_submission@omb.eop.gov. 

Martique Jones, 

Director, Regulations Development Group, 

Division B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2011–3748 Filed 2–17–11; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Submission for OMB Review; 

Comment Request 

Title: Strengthening Communities 

Fund (SCF) Performance Management 

and Evaluation Support. 

OMB No.: New Collection. 

Description: This proposed 

information collection activity is to 

obtain information from participants in 

two Strengthening Communities Fund 

(SCF) programs: The Nonprofit Capacity 

Building Program and the State, Local, 

and Tribal Government Capacity 

Building Program. Both programs are 

designed to contribute to the economic 

recovery as authorized in the American 

Recovery and Reinvestment Act of 2009 

(ARRA). The SCF evaluation is an 

important opportunity to examine 

outcomes achieved by the Strengthening 

Communities Fund and progress toward 

the objective of improving the capacity 

of organizations served by program 

grantees to address broad economic 

recovery issues in their communities. 

The evaluation will be designed to 

assess progress and measure increased 

organizational capacity of each 

participating organization. The purpose 

of this request is to receive approval of 

the data collection instruments that will 

be used in this study. 

A significant amount of information is 

already being collected through 

program-specific OMB-approved PPR 

forms or is available through secondary 

sources. Proposed surveys and phone 

interviews are very brief to reduce the 

burden on respondents. 

Respondents: 

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9582 Federal Register / Vol. 76, No. 34 / Friday, February 18, 2011 / Notices 

ANNUAL BURDEN ESTIMATES

Instrument Number of 

respondents 

Number of 

responses 

per 

respondent 

Average 

burden hours 

per response 

Total burden 

hours 

On-line Survey of SCF Grantees ..................................................................... 84 1 0.25 21 

Telephone Interview of SCF Grantees ............................................................ 84 1 1.5 126 

On-line Survey of Faith-based and Community Organizations (FBCOs) ....... 1,000 1 0.5 500 

Estimated Total Annual Burden 

Hours: 647. 

Additional Information: Copies of the 

proposed collection may be obtained by 

writing to the Administration for 

Children and Families, Office of 

Administration, Office of Information 

Services, 370 L’Enfant Promenade, SW., 

Washington, DC 20447, Attn: ACF 

Reports Clearance Officer. All requests 

should be identified by the title of the 

information collection. E-mail address: 

infocollection@acf.hhs.gov. 

OMB Comment: OMB is required to 

make a decision concerning the 

collection of information between 30 

and 60 days after publication of this 

document in the Federal Register. 

Therefore, a comment is best assured of 

having its full effect if OMB receives it 

within 30 days of publication. Written 

comments and recommendations for the 

proposed information collection should 

be sent directly to the following: 

Office of Management and Budget, 

Paperwork Reduction Project, Fax: 

202–395–7285, E-mail: 

OIRA_SUBMISSION@OMB.EOP.GOV, 

Attn: Desk Officer for the 

Administration for Children and 

Families. 

Robert Sargis, 

Reports Clearance Officer. 

[FR Doc. 2011–3745 Filed 2–17–11; 8:45 am] 

BILLING CODE 4184–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Submission for OMB Review; 

Comment Request 

Title: Income Withholding for 

Support (IWO). 

OMB No.: 0970–0154. 

Description 

Use of the OMB-approved Income 

Withholding for Support form falls 

under the authority of section 466 of the 

Act, 42 U.S.C. 666. Section 

466(b)(6)(A)(ii) of the Act requires that 

the notice given to the employer for 

income withholding in IV–D cases shall 

be in a standard format prescribed by 

the Secretary, and contain only such 

information as may be necessary for the 

employer to comply with the 

withholding order for all IV–D cases. 

Section 466(a)(8)(B)(iii) of the Act 

requires that section 466(b)(6)(A)(ii) of 

the Act be applicable also to non-IV–D 

income withholding orders. These 

provisions clearly require all 

individuals and entities to use a form 

developed by the Secretary of HHS to 

notify employers of the income 

withholding order for child support in 

all IV–D and non-IV–D cases. 

OCSE requires States’ automated 

systems to be able to automatically 

generate and download data to the OMB 

approved income withholding form. If 

child support orders are established by 

the child support agency, necessary 

information is already contained within 

the automated system for downloading 

into income withholding orders. If a 

court or other tribunal has issued a 

child support order, then agency staff 

enter the terms of the order into the 

automated system for use in issuing 

income withholding orders. Copies of 

the income withholding order are made 

for all necessary parties, and copies are 

transmitted to the employer/income 

withholder by mail or through the OCSE 

electronic income withholding order (eIWO) portal. 

The Income Withholding for Support 

form and instructions were updated for 

consistency and clarity in light of 

numerous comments suggesting 

changes, based on comments received 

during the 60-day comment period of 

the 1st Federal Register Notice 

publication. 

Respondents: Non-IV–D Custodial 

Parties and Employers. 

Previous iterations of the IWO 

omitted employers and non-IV–D CPs or 

their representatives, including 

attorneys or other entities issuing IWOs 

on behalf of CPs, as respondents; 

however, upon further review it has 

been determined that the impact on 

employers and non-IV–D CPs should be 

included in this information collection. 

This is based on the requirement that 

employers complete the ‘‘Notification of 

Termination/Income Status’’ section of 

the IWO and that non-IV–D CPs or their 

representative issuing IWOs do not have 

the information required to complete 

the IWO contained in an automated 

system and therefore are required to 

manually issue IWOs to employers/ 

income withholders. The annual burden 

estimates for employers and CPs is 

captured in number 12. 

ANNUAL BURDEN ESTIMATES

Type of respondent Number of 

respondents 

Number of 

responses 

per 

respondent 

Average 

burden hours 

per response 

(min) 

Total burden 

hours 

Employers ........................................................................................................ 1,232,622 8 2 312,264 

Non-IV–D CPs ................................................................................................. 1,969,044 1 5 164,087 

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