65602 Federal Register / Vol. 69, No. 219 / Monday, November 15, 2004 / Notices 

SUPPLEMENTARY INFORMATION: Under the 

PRA (44 U.S.C. 3501–3520), Federal 

agencies must obtain approval from the 

Office of Management and Budget 

(OMB) for each collection of 

information they conduct or sponsor. 

‘‘Collection of information’’ is defined 

in 44 U.S.C. 3502(3) and 5 CFR 

1320.3(c) and includes agency request 

or requirements that members of the 

public submit reports, keep records, or 

provide information to a third party. 

Section 3506(c)(2)(A) of the PRA (44 

U.S.C. 3506(c)(2)(A)) requires Federal 

agencies to provide a 60-day notice in 

the Federal Register concerning each 

proposed collection of information, 

including each proposed extension of an 

existing collection of information, 

before submitting the collection to OMB 

for approval. To comply with this 

requirement, AoA is publishing notice 

of the proposed collection of 

information set forth in this document. 

With respect to the following collection 

of information, AoA invites comments 

on: (1) Whether the proposed collection 

of information is necessary for the 

proper performance of AoA’s functions, 

including whether the information will 

have practical utility; (2) the accuracy of 

AoA’s estimate of the burden of the 

proposed collection of information, 

including the validity of the 

methodology and assumptions used; (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 

when appropriate, and other forms of 

information technology. AoA estimates 

the burden of this collection of 

information as follows: 

Frequency: Annually. 

Respondents: Medicare beneficiaries 

after SMP education/training on fraud 

prevention; administered by staff or 

senior volunteers in 57 SMP projects 

nationwide. 

Estimated number of responses:

21,000. 

Total Estimated Burden Hours: 2,300.

Josefina G. Carbonell, 

Assistant Secretary for Aging.

[FR Doc. 04–25241 Filed 11–12–04; 8:45 am] 

BILLING CODE 4154–01–P

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare and Medicaid 

Services 

[Document Identifier: CMS–R–185, CMS 

10131, CMS–10054 and CMS–R–50] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request

AGENCY: Centers for Medicare and 

Medicaid Services. 

In compliance with the requirement 

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

Paperwork Reduction Act of 1995, the 

Centers for Medicare and Medicaid 

Services (CMS) (formerly known as the 

Health Care Financing Administration 

(HCFA)), 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 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: Granting and 

Withdrawal of Deeming Authority to 

Private Nonprofit Accreditation 

Organizations and of State Exemption 

Under State Laboratory Programs and 

Supporting Regulations in 42 CFR 

493.551–493.557; Use: The information 

required is necessary to determine 

whether a private accreditation 

organization’s or State licensure 

program’s standards and accreditation/

licensure process is equal to or more 

stringent than those of CLIA. Form 

Number: CMS–R–185 (OMB#: 0938–

0686); Frequency: Initial application 

and as needed; Affected Public: Not-forprofit institutions, Business or other forprofit and State, Local, or Tribal 

Government; Number of Respondents: 8; 

Total Annual Responses: 76; Total 

Annual Hours: 768. 

2. Type of Information Collection 

Request: New Collection; Title of 

Information Collection: Evaluation of 

Medicare Disease Management 

Demonstrations; Form No.: CMS–10131 

(OMB# 0938–NEW); Use: CMS 

contracted with Mathematic Policy 

Research, Inc. (MPR) for the evaluation 

of disease management programs. The 

purpose of the patient survey is to 

assess the impact of disease 

management and prescription drug 

benefits on patient health, functioning 

status, care satisfaction, health 

behaviors and knowledge of condition. 

Data from the physician survey will be 

used to assess physician satisfaction 

with disease management services, 

physician perceptions of the impact of 

disease management on patient 

outcomes, education and service use, 

and the impact of disease management 

programs on physician practices and 

office workload.; Frequency: On 

Occasion; Affected Public: Individuals 

or households, Business or other forprofit; Number of Respondents: 5000; 

Total Annual Responses: 2500; Total 

Annual Hours: 1625. 

3. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Recognition of 

Payment for New Technology Services 

for Ambulatory Payment Classifications 

(APCs) under the Outpatient 

Prospective Payment System and 

Supporting Regulations in 42 CFR, 

413.65 and 419.42; Form No.: CMS–

10054 (OMB# 0938–0860); Use:

Information is necessary to determine 

services eligible for payment in new 

technology ambulatory payment 

classifications (APCs) in the outpatient 

prospective payment system; Frequency:

On Occasion; Affected Public: Business 

or other for-profit; Number of 

Respondents: 15; Total Annual 

Responses: 15; Total Annual Hours:

180. 

4. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Medical Records 

Review under PPS and Supporting 

Regulations in 42 CFR, Sections 412.40–

412.52; Form No.: CMS–R–50 (OMB# 

0938–0359); Use: The Quality 

Improvement Organizations (QIOs) are 

authorized to conduct medical review 

activities under the Prospective 

Payment System (PPS) . In order to 

conduct these review activites, the 

agency depends upon hospitals to make 

available specific records regarding care 

provided to Medicare beneficiaries. The 

Clinical Data Abstraction Centers 

(CDACs) obtain copies of medical 

records from which they abstract data to 

analyze patterns of care and outcomes 

for heart failure/myocardial infarction, 

pneumonia, diabetes and surgical 

infection.; Frequency: Other: when 

records are reviewed; Affected Public:

Federal Register / Vol. 69, No. 219 / Monday, November 15, 2004 / Notices 65603

Business or other for-profit, Not-forprofit institutions, Federal Government, 

and State, Local or Tribal Govt.; Number 

of Respondents: 6,100; Total Annual 

Responses: 397,500; Total Annual 

Hours: 11,925. 

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/

regulations/pra/, 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. 

Written comments and 

recommendations for the proposed 

information collections must be mailed 

within 60 days of this notice directly to 

the CMS Paperwork Clearance Officer 

designated at the following address: 

CMS, Office of Strategic Operations and 

Regulatory Affairs, Division of 

Regulations Development and 

Issuances, Attention: Melissa Musotto, 

Room C5–14–03, 7500 Security 

Boulevard, Baltimore, Maryland 21244–

1850.

Dated: November 5, 2004. 

John P. Burke, III, 

Paperwork Reduction Act Team Leader, 

Office of Strategic Operations and Strategic 

Affairs, Division of Regulations Development 

and Issuances.

[FR Doc. 04–25250 Filed 11–12–04; 8:45 am] 

BILLING CODE 4120–03–P

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Indian Health Service 

SES Executive Review Board/

Performance Review Board

AGENCY: Indian Health Service.

ACTION: Notice.

SUMMARY: Notice is hereby given of the 

appointment of members of the Indian 

Health Service (IHS) Senior Executive 

Service (SES) Executive Review Board/

SES Performance Review Board.

FOR FURTHER INFORMATION CONTACT:

Phyllis Eddy, Acting Director, Office of 

Management Services, 801 Thompson 

Avenue, Suite 120, Rockville, Maryland 

20852, (301) 443–6290.

SUPPLEMENTARY INFORMATION: Section 

4314(c) (1) through (5) of Title 5, U.S.C., 

requires each agency to establish, in 

accordance with regulations prescribed 

by the Office of Personnel Management, 

one or more SES performance review 

boards. The board reviews and evaluates 

the initial appraisal of a senior 

executive’s performance by the 

supervisor and considers 

recommendations to the appointing 

authority regarding the performance of 

the senior executive. 

The following have been designated 

as regular members of the Senior 

Executive Service (SES) Executive 

Review Board/SES Performance Review 

Board for IHS: Phyllis Eddy, Chair; 

Elaine Perry, Deputy Director, Office of 

the Administrator, Substance Abuse and 

Mental Health Services Administration; 

Robert G. McSwain, Acting Deputy 

Director, Management Operations; Gary 

Hartz, Acting Deputy Director, IHS; 

Chris Mandregan, Jr., Director, Alaska 

Area IHS; Doni Wilder, Director, 

Portland Area IHS; John Hubbard, 

Director, Navajo Area IHS.

Dated: November 5, 2004. 

Charles W. Grim, 

Assistant Surgeon General, Director.

[FR Doc. 04–25244 Filed 11–12–04; 8:45 am] 

BILLING CODE 4160–16–M

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Office of Inspector General 

Program Exclusions: October 2004

AGENCY: Office of Inspector General, 

HHS.

ACTION: Notice of program exclusions.

During the month of October 2004, 

the HHS Office of Inspector General 

imposed exclusions in the cases set 

forth below. When an exclusions is 

imposed, no program payment is made 

to anyone for any items or services 

(other than an emergency item or 

service not provided in a hospital 

emergency room) furnished, ordered or 

prescribed by an excluded party under 

the Medicare, Medicaid, and all Federal 

Health Care programs. In addition, no 

program payment is made to any 

business or facility, e.g., a hospital, that 

submits bills for payment for items or 

services provided by an excluded party. 

Program beneficiaries remain free to 

decide for themselves whether they will 

continue to use the services of an 

excluded party even though no program 

payments will be made for items and 

services provided by that excluded 

party. The exclusions have national 

effect and also apply to all Executive 

Branch procurement and nonprocurement programs and activities.

Subject name Address Effective date 

PROGRAM-RELATED CONVICTIONS

ARMON, BOBBY ...................................................................... MILWAUKEE, WI ..................................................................... 11/18/2004 

ARNOLD, RODELL .................................................................. TOLEDO, OH ........................................................................... 11/18/2004 

ARRUDA, CARMEN ................................................................. ISSAQUAH, WA ....................................................................... 11/18/2004 

BAUMAN, DAVID ..................................................................... HOUSTON, TX ......................................................................... 11/18/2004 

BROWN, AUWANA .................................................................. FRESNO, CA ........................................................................... 11/18/2004 

CABRERA, MARCO ................................................................. MIAMI, FL ................................................................................. 11/18/2004 

CARTER, JERRY ..................................................................... DYERSBURG, TN .................................................................... 11/18/2004 

CASIANO, ROSARIO ............................................................... ROSEMEAD, CA ...................................................................... 11/18/2004 

CORBETT, KERMIS ................................................................. ELGIN, SC ............................................................................... 11/18/2004 

CORTES, FRANCISCO ............................................................ HIALEAH, FL ............................................................................ 11/18/2004 

DAY, APRIL .............................................................................. LOS ANGELES, CA ................................................................. 11/18/2004 

DELEON, VANESSA ................................................................ HAWTHORNE, CA ................................................................... 11/18/2004 

ELBAGDADI, HAZEM ............................................................... PETERSBURG, VA .................................................................. 11/18/2004 

ENCINAS, BENJAMIN .............................................................. TUCSON, AZ ........................................................................... 11/18/2004 

FATEMI, MOHAMMAD ............................................................. DUNKIRK, MD ......................................................................... 11/18/2004 

FINDLEY, KATHERINE ............................................................ LAKEWOOD, CO ..................................................................... 11/18/2004 

FORD, FRED ............................................................................ EGLIN AFB, FL ........................................................................ 11/18/2004 

FREITAS, JOHN ....................................................................... CARTNEGE, MO ..................................................................... 11/18/2004 

GONZALEZ, GIORDY .............................................................. MIAMI, FL ................................................................................. 11/18/2004 

GONZALEZ, MILAGROS ......................................................... MIAMI, FL ................................................................................. 11/18/2004