Federal Register / Vol. 76, No. 46 / Wednesday, March 9, 2011 / Notices 12965 

from the ongoing BRFSS as well as 

additional questions taken from 

standardized scales or from other 

surveys designed to measure anxiety, 

depression, and potential stressassociated physical health effects. 

The survey questionnaire was 

developed by DBS in partnership with 

the Substance Abuse and Mental Health 

Services Administration (SAMHSA) and 

state public health and mental health 

departments from Louisiana, 

Mississippi, Alabama, and Florida, 

where the survey is being conducted. 

Coastal counties within 32 miles of an 

area where fishing was closed due to the 

Deepwater Horizon Event were selected 

for inclusion. These include the 

following Gulf coast counties: 

Louisiana: Assumption Parish, 

Calcasieu Parish, Cameron Parish, 

Iberia Parish, Jefferson Parish, 

Jefferson Davis Parish, Lafourche 

Parish, Orleans Parish, Plaquemines 

Parish, St. Bernard Parish, St. Charles 

Parish, St. Mary Parish, St. Tammany 

Parish, Tangipahoa Parish, 

Terrebonne Parish, Vermilion Parish 

Mississippi: Hancock County, Harrison 

County, Jackson County 

Alabama: Baldwin County, Mobile 

County 

Florida: Escambia County, Okaloosa 

County, Santa Rosa County, Walton 

County 

Since the publication of the 60-day 

Federal Register Notice, DBS proposes 

to include the following modifications 

to the Gulf States Population Survey. 

• Addition of a Spanish translation of 

the questionnaire. 

• Minor modifications in the wording 

of some survey questions to improve 

respondent’s understanding of the 

question. 

• Extension of the sample area to the 

entirety of the four states (AL, FL, LA, 

MS), which will allow comparison of 

results from the Gulf Coast counties to 

non-Gulf Coast counties. 

• Addition of cellular phones to the 

sampling frame. Extension of the sample 

area to the entirety of the four states 

(AL, FL, LA, MS) will allow DBS to 

sample cellular phone responses in 

addition to land-line telephones. This 

will improve the survey 

representativeness because those who 

have a cellular phone, but no land-line 

telephone, have a demographic profile 

that differs from those who do have 

land-line telephones. 

The objective of the survey is to 

provide state health and mental health 

departments, SAMHSA, and other 

appropriate organizations data they 

need to assess the need for mental and 

behavioral health services in the 

selected counties and to inform the 

provision of those services. 

The telephone survey will collect data 

from a random sample of telephone 

households which include landline and 

cellular phone telephones in the 

selected counties. Approximately 2,500 

interviews will be completed each 

month in the targeted coastal areas and 

approximately 1,250 interviews will be 

completed in the comparison areas. 

Adults 18 years or older will be asked 

to take part in the survey, but only one 

adult per household will be 

interviewed. Potential respondents will 

be notified through an introductory 

script that participation is voluntary and 

they will not be compensated for 

participating. For those who agree to 

participate, interviews should last 

approximately 30 minutes. 

Since the OMB emergency clearance 

for the DBS Gulf States Population 

Survey expires April 30, 2011, DBS is 

submitting and information collection 

request (ICR) to continue data collection 

for one year. 

Preliminary data from the survey will 

be available to SAMHSA and 

participating states monthly (pending 

sample size). The final dataset and 

analyses will be provided to SAMHSA 

and participating states in January 2012. 

There is no cost to respondents other 

than their time. The total estimated 

annual burden hours are 20,000. 

ESTIMATED ANNUALIZED BURDEN HOURS

Respondents Form Group Number of respondents 

Number responses per 

respondent 

Average burden per 

pesponse 

(in hours) 

Individuals ..................................... GSPS ..................... Coastal Counties ......................... 30,000 1 30/60 

Comparison Group Counties ....... 10,000 1 30/60 

Catina Conner, 

Acting Reports Clearance Officer, Centers for 

Disease Control and Prevention. 

[FR Doc. 2011–5294 Filed 3–8–11; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10232 and CMS– 

R–211] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, HHS. 

In compliance with the requirement 

of section 3506(c)(2)(A) of the 

Paperwork Reduction Act of 1995, the 

Centers for Medicare & Medicaid 

Services (CMS) is publishing the 

following summary of proposed 

collections for public comment. 

Interested persons are invited to send 

comments regarding this burden 

estimate or any other aspect of this 

collection of information, including any 

of the following subjects: (1) The 

necessity and utility of the proposed 

information collection for the proper 

performance of the agency’s functions; 

(2) the accuracy of the estimated 

burden; (3) ways to enhance the quality, 

utility, and clarity of the information to 

be collected; and (4) the use of 

automated collection techniques or 

other forms of information technology to 

minimize the information collection 

burden. 

1. Type of Information Collection 

Request: Revision of currently approved 

collection; Title of Information 

Collection: State Plan Template to 

Implement Section 6062 of the Deficit 

Reduction Act; Form No.: CMS–10232 

(OMB#: 0938–1045); Use: The Deficit 

Reduction Act (DRA) provides States 

with numerous flexibilities in operating 

their State Medicaid Programs. Section 

6062 of the DRA (Opportunity for 

families of Disabled Children to 

Purchase Medicaid Coverage for Such 

Children) provides States the 

opportunity to provide Medicaid 

benefits to disabled children who would 

otherwise be ineligible because of 

family income that is above the State’s 

highest Medicaid eligibility standards 

for children. States must establish a 

State Plan for medical assistance to 

implement this provision. To do this, 


Emcdonald on DSK2BSOYB1PROD with NOTICES
12966 Federal Register / Vol. 76, No. 46 / Wednesday, March 9, 2011 / Notices 

State Medicaid Agencies will complete 

the template. CMS will review the 

information to determine if the State has 

met all the requirements of the DRA 

provision; Frequency: Once; Affected 

Public: State, Federal, or Tribal 

Governments; Number of Respondents: 

56; Total Annual Responses: 10; Total 

Annual Hours: 60. (For policy questions 

regarding this collection contact Barbara 

Washington at 410–786–9964. For all 

other issues call 410–786–1326.) 

2. Type of Information Collection 

Request: Revision of currently approved 

collection; Title of Information 

Collection: Model Application Template 

and Instructions for State Child Health 

Plan Under Title XXI of the Social 

Security Act, State Children’s Health 

Insurance Program; Form No.: CMS–R– 

211 (OMB#: 0938–0707); Use: The 

information will be used to assess State 

plan performance and health outcomes 

and to evaluate the amount of substitute 

private coverage and the effect of 

subsidies on access to coverage; 

Frequency: Yearly, occasionally; 

Affected Public: State, Federal, or Tribal 

Governments; Number of Respondents: 

40; Total Annual Responses: 40; Total 

Annual Hours: 3,200. (For policy 

questions regarding this collection 

contact Nancy Goetschius at 410–786– 

0707. 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 

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

PaperworkReductionActof1995, or email your request, including your 

address, phone number, OMB number, 

and CMS document identifier, to 

Paperwork@cms.hhs.gov, or call the 

Reports Clearance Office at 410–786– 

1326. 

In commenting on the proposed 

information collections please reference 

the document identifier or OMB control 

number. To be assured consideration, 

comments and recommendations must 

be submitted in one of the following 

ways by May 9, 2011: 

1. Electronically. You may submit 

your comments electronically to http:// 

www.regulations.gov. Follow the 

instructions for ‘‘Comment or 

Submission’’ or ‘‘More Search Options’’ 

to find the information collection 

document(s) accepting comments. 

2. By regular mail. You may mail 

written comments to the following 

address: CMS, Office of Strategic 

Operations and Regulatory Affairs, 

Division of Regulations Development, 

Attention: Document Identifier/OMB 

Control Number, Room C4–26–05, 7500 

Security Boulevard, Baltimore, 

Maryland 21244–1850. 

Dated: February 28, 2011. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2011–5365 Filed 3–4–11; 4:15 pm] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Comment Request 

Title: Measurement Development: 

Quality of Caregiver-Child Interactions 

for Infants and Toddlers (Q–CCIIT). 

OMB No.: New Collection. 

Description: The Office of Planning, 

Research and Evaluation (OPRE), 

Administration for Children and 

Families (ACE), U.S. Department of 

Health and Human Services (HHS), is 

proposing to develop a new observation 

measure to assess the quality of child 

care settings, specifically the quality of 

caregiver-child interaction for infants 

and toddlers in nonparental care. The 

measure will be appropriate for use 

across child care settings, center-based 

and family child care settings as well as 

single- and mixed-age classrooms. 

The two-year data collection activity 

will include two phases: (1) A pilot test 

and (2) a psychometric field test. We 

will request information about the child 

care setting, its classrooms and families 

for recruitment into the study. 

Information will be collected through 

observations, focus groups, and 

questionnaires. 

In the pilot and field tests, the new Q– 

CCIIT observation measure will include 

observing a small group activity 

structured with a common task and 

asking follow-up observation questions. 

Caregivers observed will also complete 

a background questionnaire. Focus 

groups to obtain stakeholder input on 

caregiver-child interactions will be 

conducted separately with parents, 

caregivers, and training and technical 

assistance providers. Focus group 

participants will also complete a 

demographic questionnaire. Parents of 

children served by caregivers will 

complete a questionnaire on their 

child’s competencies related to 

cognitive, language/communication, 

and social-emotional development. 

Parents will complete this 

questionnaire, which will also include 

family and child characteristics, once in 

the pilot test and twice in the field test, 

at the start of the field test and 6 months 

later to assess growth. 

The purpose of this data collection is 

to support the 2007 reauthorization of 

the Head Start program (Pub. L. 110– 

134), which calls for periodic 

assessments of Head Start’s quality and 

effectiveness. 

Respondents: Child care setting 

representatives (directors or owners), 

caregivers (center-based and family 

child care settings), parents of children 

in those child care settings, and training 

and technical assistance providers. 

ANNUAL BURDEN ESTIMATES

Instrument 

Annual number of respondents 

Number of responses per 

hour per respondent 

Average burden 

hour per response 

Estimated annual burden 

hours 

Child care setting recruitment form ............................................................... 190 1 0 .5 95 

Q–CCIIT measure-small group activity and follow-up ................................... 290 1 0 .25 73 

Caregiver background questionnaire ............................................................. 520 1 0 .25 130 

Focus group interview guide ......................................................................... 20 1 1 .90 38 

Parent focus group demographic questionnaire ........................................... 10 1 0 .10 1 

Caregiver focus group demographic questionnaire ....................................... 5 1 0 .10 1 

Training and technical assistance provider focus group demographic questionnaire ...................................................................................................... 5 1 0 .10 1 

Parent-report child competence questionnaire .............................................. 880 2 0 .75 1,320 


Emcdonald on DSK2BSOYB1PROD with NOTICES