23566 Federal Register / Vol. 78, No. 76 / Friday, April 19, 2013 / Notices 

or bank holding company. The factors 

that are considered in acting on the 

notices are set forth in paragraph 7 of 

the Act (12 U.S.C. 1817(j)(7)). 

The notices are available for 

immediate inspection at the Federal 

Reserve Bank indicated. The notices 

also will be available for inspection at 

the offices of the Board of Governors. 

Interested persons may express their 

views in writing to the Reserve Bank 

indicated for that notice or to the offices 

of the Board of Governors. Comments 

must be received not later than May 6, 

2013. 

A. Federal Reserve Bank of 

Minneapolis (Jacqueline G. King, 

Community Affairs Officer) 90 

Hennepin Avenue, Minneapolis, 

Minnesota 55480–0291: 

1. Thomas W. Armstrong, and Bradley 

A. Trimner, individually and as CoTrustees of the Arnold J. Stueber, Sr. 

Revocable Trust, and the Sadie A. 

Stueber Revocable Trust, and Mary 

Luethmers, all of Park Falls, Wisconsin, 

individually, to each retain voting 

shares of Park Falls Agency, Inc., and 

thereby indirectly retain voting shares of 

The First National Bank of Park Falls, 

both in Park Falls, Wisconsin. 

Board of Governors of the Federal Reserve 

System, April 16, 2013. 

Margaret McCloskey Shanks, 

Deputy Secretary of the Board. 

[FR Doc. 2013–09220 Filed 4–18–13; 8:45 am] 

BILLING CODE 6210–01–P 

FEDERAL RESERVE SYSTEM 

Formations of, Acquisitions by, and 

Mergers of Bank Holding Companies; 

Correction 

This notice corrects a notice (FR Doc. 

2013–08630) published on pages 21949– 

21950 of the issue for Friday, April 12, 

2013. 

Under the Federal Reserve Bank of St. 

Louis heading, the entry for Hopfed 

Bancorp, Inc., Hopkinsville, Kentucky, 

is revised to read as follows: 

A. Federal Reserve Bank of St. Louis 

(Yvonne Sparks, Community 

Development Officer) P.O. Box 442, St. 

Louis, Missouri 63166–2034: 

1. Hopfed Bancorp, Inc., 

Hopkinsville, Kentucky; to become a 

bank holding company through the 

conversion of its wholly owned 

subsidiary, Heritage Bank, Hopkinsville, 

Kentucky, from a federally chartered 

savings bank to a state charted 

commercial bank. 

Comments on this application must 

be received by May 9, 2013. 

Board of Governors of the Federal Reserve 

System, April 16, 2013. 

Margaret McCloskey Shanks, 

Deputy Secretary of the Board. 

[FR Doc. 2013–09219 Filed 4–18–13; 8:45 am] 

BILLING CODE 6210–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers: CMS–10108, CMS– 

10268, CMS–10316, and CMS–10478] 

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: Extension of a currently 

approved collection; Title of 

Information Collection: Medicaid 

Managed Care Regulations; Use: 

Medicaid enrollees use the information 

collected and reported to make 

informed choices regarding health care, 

including how to access health care 

services and the grievance and appeal 

system. States use the information 

collected and reported as part of its 

contracting process with managed care 

entities, as well as its compliance 

oversight role. The CMS uses the 

information collected and reported in an 

oversight role of state Medicaid 

managed care programs. Form Number: 

CMS–10108 (OCN: 0938–0920); 

Frequency: Occasionally; Affected 

Public: Individuals or households, 

Private sector (business or other forprofit and not-for-profit institutions), 

and State, local or Tribal Government; 

Number of Respondents: 1,640,223; 

Total Annual Responses: 5,217,333; 

Total Annual Hours: 5,872,255. (For 

policy questions regarding this 

collection contact Amy Gentile at 410– 

786–3499. For all other issues call 410– 

786–1326.) 

2. Type of Information Collection 

Request: Reinstatement of a currently 

approved collection; Title of 

Information Collection: Consolidated 

Renal Operations in a Web Enabled 

Network (CROWNWeb) Third-party 

Submission Authorization Form Use: 

The Consolidated Renal Operations in a 

Web Enabled Network (CROWNWeb) 

Third-Party Submission Authorization 

(CWTPSA) form is to be completed by 

‘‘Facility Administrators’’ 

(administrators of CMS-certified dialysis 

facilities) if they intend to authorize a 

third party (a business with which the 

facility is associated, or an independent 

vendor) to submit data to CMS to 

comply with the recently-revised 

Conditions for Coverage of dialysis 

facilities. The CROWNWeb system is 

the system used as the collection point 

of data necessary for entitlement of 

ESRD patients to Medicare benefits and 

for Federal Government monitoring and 

assessing of the quality and types of care 

provided to renal patients. The 

information collected through the 

CWTPSA form will allow CMS and its 

contractors to receive data from 

authorized parties acting on behalf of 

CMS-certified dialysis facilities. Since 

February 2009, CMS has received 4,160 

CWTPSA forms and anticipates that 

they will continue to receive no more 

than 400 new CWTPSA forms annually 

to address the creation of new facilities 

under the current participating ‘‘third 

party submitters.’’ Form Number: CMS– 

10268 (OCN: 0938–1052); Frequency: 

Occasionally; Affected Public: Private 

Sector; Business or other for-profits and 

Not-for-profit institutions; Number of 

Respondents: 400; Total Annual 

Responses: 400; Total Annual Hours: 

34. (For policy questions regarding this 

collection contact Michelle Tucker at 

410–786–0736. For all other issues call 

410–786–1326.) 

3. Type of Information Collection 

Request: Revision of a currently 

approved collection. Title of 

Information Collection: Implementation 

of the Medicare Prescription Drug Plan 

(PDP) and Medicare Advantage (MA) 

Plan Disenrollment Reasons Survey. 

Use: This data collection complements 

the satisfaction data collected through 

the Medicare Consumer Assessment of 

Healthcare Providers and Systems 

survey by providing dissatisfaction data 

in the form of reasons for disenrollment 

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Federal Register / Vol. 78, No. 76 / Friday, April 19, 2013 / Notices 23567 

from a Prescription Drug Plan. The data 

collected in this survey can be used to 

improve the operation of Medicare 

Advantage (both MA and MA–PD) 

contracts and standalone PDPs through 

the identification of beneficiary 

disenrollment reasons. Plans can use the 

information to guide quality 

improvement efforts. The data can also 

be used by beneficiaries who need to 

choose among the different MA and PDP 

options. To the extent that these data 

identify areas for improvement at the 

contract level they can be used to 

inform CMS contract oversight. Form 

Number: CMS–10316 (OCN: 0938– 

1113). Frequency: Yearly; Affected 

Public: Individuals or households; 

Number of Respondents: 88,492; Total 

Annual Responses: 88,492; Total 

Annual Hours: 22,887. (For policy 

questions regarding this collection 

contact Sai Ma at 410–786–1479. For all 

other issues call 410–786–1326.) 

4. Type of Information Collection 

Request: New collection (request for a 

new OMB control number). Title of 

Information Collection: National 

Implementation of In-Center 

Hemodialysis CAHPS Survey. Use: Data 

collected in the national 

implementation of the In-center 

Hemodialysis Consumer Assessment of 

Healthcare Providers and Systems 

(CAHPS) Survey will be used for the 

following purposes: (1) To provide a 

source of information from which 

selected measures can be publicly 

reported to beneficiaries as a decision 

aid for dialysis facility selection; (2) to 

aid facilities with their internal quality 

improvement efforts and external 

benchmarking with other facilities; (3) 

to provide CMS with information for 

monitoring and public reporting 

purposes; and (4) to support the endstage renal disease value-based 

purchasing program. Form Number: 

CMS–10478 (OCN: 0938–New); 

Frequency: Semi-annually and once; 

Affected Public: Individuals or 

households; Number of Respondents: 

165,000; Total Annual Responses: 

165,000; Total Annual Hours: 87,750. 

(For policy questions regarding this 

collection contact Elizabeth Goldstein at 

410–786–6665. 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 

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 on (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 June 18, 2013: 

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 ll, Room C4–26–05, 

7500 Security Boulevard, Baltimore, 

Maryland 21244–1850. 

Dated: April 16, 2013. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2013–09267 Filed 4–18–13; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers: CMS–576A] 

Agency Information Collection 

Activities: Submission for OMB 

Review; 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), Department of Health 

and Human Services, 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 function; 

(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: Extension of a currently 

approved collection; Title of 

Information Collection: Organ 

Procurement Organization’s (OPOs) 

Health Insurance Benefits Agreement 

and Supporting Regulations at 42 CFR 

486.301–486.348; Use: The Medicare 

and Medicaid Programs final conditions 

for coverage for Organ Procurement 

Organizations (OPOs) require OPOs to 

sign agreements with the Center for 

Medicare and Medicaid Services (CMS) 

in order to be reimbursed and perform 

their services. The information provided 

on this form serves as a basis for 

continuing the agreements with CMS 

and the OPOs for participation in the 

Medicare and Medicaid programs for 

reimbursement of service. Form 

Number: CMS–576A (OCN: 0938–0512); 

Frequency: Occasionally; Affected 

Public: Private Sector: Business or other 

for-profit and not-for-profit institutions; 

Number of Respondents: 58; Total 

Annual Responses: 58; Total Annual 

Hours: 116. (For policy questions 

regarding this collection contact Melissa 

Rice at 410–786–3270. 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 

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 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 May 20, 2013. 

OMB, Office of Information and 

Regulatory Affairs, Attention: CMS 

Desk Officer, Fax Number: (202) 395– 

6974, Email: 

OIRA_submission@omb.eop.gov 

Dated: April 16, 2013. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2013–09256 Filed 4–18–13; 8:45 am] 

BILLING CODE 4120–01–P 

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