Federal Register / Vol. 80, No. 75 / Monday, April 20, 2015 / Notices 21721 

CMS–179 State Plan Under Title XIX 

of the Social Security Act (Base Plan 

Pages, Attachments, Supplements to 

Attachments) 

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. 

The term ‘‘collection of information’’ is 

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

1320.3(c) and includes agency requests 

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 

requires federal agencies to publish a 

60-day notice in the Federal Register 

concerning each proposed collection of 

information, including each proposed 

extension or reinstatement of an existing 

collection of information, before 

submitting the collection to OMB for 

approval. To comply with this 

requirement, CMS is publishing this 

notice. 

Information Collection 

1. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Medicaid State 

Plan Base Plan Pages; Use: State 

Medicaid agencies complete the plan 

pages while we review the information 

to determine if the state has met all of 

the requirements of the provisions the 

states choose to implement. If the 

requirements are met, we will approve 

the amendments to the state’s Medicaid 

plan giving the state the authority to 

implement the flexibilities. For a state to 

receive Medicaid Title XIX funding, 

there must be an approved Title XIX 

state plan. Form Number: CMS–179 

(OMB control number 0938–0193); 

Frequency: Occasionally; Affected 

Public: State, Local, and Tribal 

Governments; Number of Respondents: 

56; Total Annual Responses: 1,120; 

Total Annual Hours: 22,400. (For policy 

questions regarding this collection 

contact Annette Pearson at 410–786– 

6958.) 

Dated: April 15, 2015. 

William N. Parham, III, 

Director, Paperwork Reduction Staff, Office 

of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2015–09008 Filed 4–17–15; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–855R, CMS– 

10394, CMS–10371, CMS–10472 and CMS– 

10494] 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

ACTION: Notice. 

SUMMARY: The Centers for Medicare & 

Medicaid Services (CMS) is announcing 

an opportunity for the public to 

comment on CMS’ intention to collect 

information from the public. Under the 

Paperwork Reduction Act of 1995 

(PRA), federal agencies are required to 

publish notice in the Federal Register 

concerning each proposed collection of 

information, including each proposed 

extension or reinstatement of an existing 

collection of information, and to allow 

a second opportunity for public 

comment on the notice. Interested 

persons are invited to send comments 

regarding the 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. 

DATES: Comments on the collection(s) of 

information must be received by the 

OMB desk officer by May 20, 2015. 

ADDRESSES: When commenting on the 

proposed information collections, 

please reference the document identifier 

or OMB control number. To be assured 

consideration, comments and 

recommendations must be received by 

the OMB desk officer via one of the 

following transmissions: OMB, Office of 

Information and Regulatory Affairs, 

Attention: CMS Desk Officer, Fax 

Number: (202) 395–5806 OR, Email: 

OIRA_submission@omb.eop.gov. 

To obtain copies of a supporting 

statement and any related forms for the 

proposed collection(s) summarized in 

this notice, you may make your request 

using one of following: 

1. Access CMS’ Web site address at 

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

ReductionActof1995. 

2. Email your request, including your 

address, phone number, OMB number, 

and CMS document identifier, to 

Paperwork@cms.hhs.gov. 

3. Call the Reports Clearance Office at 

(410) 786–1326. 

FOR FURTHER INFORMATION CONTACT: 

Reports Clearance Office at (410) 786– 

1326. 

SUPPLEMENTARY INFORMATION: Under the 

Paperwork Reduction Act of 1995 (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. The term ‘‘collection of 

information’’ is defined in 44 U.S.C. 

3502(3) and 5 CFR 1320.3(c) and 

includes agency requests 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 publish a 30-day notice in the 

Federal Register concerning each 

proposed collection of information, 

including each proposed extension or 

reinstatement of an existing collection 

of information, before submitting the 

collection to OMB for approval. To 

comply with this requirement, CMS is 

publishing this notice that summarizes 

the following proposed collection(s) of 

information for public comment: 

1. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Medicare 

Enrollment Application: Reassignment 

of Medicare Benefits; Use: The primary 

function of the CMS 855R enrollment 

application is to allow physicians and 

non-physician practitioners to reassign 

their Medicare benefits to a group 

practice and to gather information from 

the individual that tells us who he/she 

is, where he or she renders services, and 

information necessary to establish 

correct claims payment. The goal of 

periodically evaluating and revising the 

CMS–855R enrollment application is to 

simplify and clarify the information 

collection without jeopardizing our 

need to collect specific information. At 

this time, CMS is making very few 

minor revisions to the CMS–855R 

(Reassignment of Benefits) Medicare 

enrollment application (OMB No. 0938– 

1179). Two sections within the form are 

being reversed to maintain sync with 

online and paper forms. The previously 

approved CMS 855R section 2 collected 

information regarding the individual 

practitioner who is reassigning benefits 

and section 3 collected information 

regarding the organization/group 

receiving the reassigned benefits. These 

two sections have been reversed so that 

section 2 now collects information on 

mstockstill on DSK4VPTVN1PROD with NOTICES

21722 Federal Register / Vol. 80, No. 75 / Monday, April 20, 2015 / Notices 

the regarding the organization/group 

receiving the reassigned benefits and 

section 3 now collects information on 

the individual practitioner who is 

reassigning benefits. No information or 

data collection within these sections 

was revised. The sections were merely 

re-sequenced and re-numbered to 

maintain sync between online and 

paper forms. With the exception of this 

section reversal and adding the word 

‘‘optional’’ to sections 4 and 5 (primary 

practice location and contact person 

information), there are no other 

revisions. These revisions offer no new 

data collection in this revision package. 

The addition of the optional choice in 

sections 4 and 5 could potentially 

reduce the burden to providers who 

choose not to complete either or both 

optional sections. Form Number: CMS– 

855R (OMB control number 0938–1179); 

Frequency: Occasionally; Affected 

Public: State, Local, or Tribal 

Governments, Private sector (For-profit 

and Not-for-profit institutions); Number 

of Respondents: 379,619; Total Annual 

Responses: 379,619; Total Annual 

Hours: 94,905. (For policy questions 

regarding this collection contact Kim 

McPhillips at 410–786–7278). 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Application to 

Be a Qualified Entity to Receive 

Medicare Data for Performance 

Measurement; Use: Section 10332 of the 

Patient Protection and Affordable Care 

Act (ACA) requires the Secretary to 

make standardized extracts of Medicare 

claims data under parts A, B, and D 

available to ‘‘qualified entities’’ for the 

evaluation of the performance of 

providers of services and suppliers. The 

statute provides the Secretary with 

discretion to establish criteria to 

determine whether an entity is qualified 

to use claims data to evaluate the 

performance of providers of services 

and suppliers. We are proposing at 

section 42 CFR 401.703 to evaluate an 

organization’s eligibility across three 

areas: Organizational and governance 

capabilities, addition of claims data 

from other sources (as required in the 

statute), and data privacy and security. 

This is the application through which 

organizations will provide information 

to CMS to determine whether they will 

be approved as a qualified entity. Form 

Number: CMS–10394 (OMB control 

number: 0938–1144); Frequency: 

Occasionally; Affected Public: Private 

sector—Business or other for-profits and 

Not-for-profit institutions; Number of 

Respondents: 35; Total Annual 

Responses: 35; Total Annual Hours: 

6,833. (For policy questions regarding 

this collection contact Kari Gaare at 

410–786–8612). 

3. Type of Information Collection 

Request: Revision of a currently 

approved information collection; Title 

of Information Collection: Cooperative 

Agreements to Support Establishment of 

State-Operated Health Insurance 

Exchanges; Use: All States (including 

the 50 States, consortia of States, and 

the District of Columbia herein referred 

to as States) had the opportunity under 

section 1311(b) of the Affordable Care to 

apply for three types of grants: (1) 

Planning grants; (2) Early Innovator 

grants for early development of 

information technology; and (3) 

Establishment grants to develop, 

implement and start-up Marketplaces. 

As of January 1st, 2015, the Secretary 

has disbursed over $5.4 billion under 

this grant program and, as of that date, 

there were 79 active establishment 

grants awarded to 28 states. As the 

State-Based Marketplaces (SBM) and 

Small Business Health Options Program 

(SHOP) have matured and moved from 

the developmental phases to fulloperation, the reporting requirements 

for the states have been modified and 

streamlined to insure only information 

necessary to provide effective oversight 

of their operations by CMS is collected. 

Given the innovative nature of 

Exchanges and the statutorilyprescribed relationship between the 

Secretary and States in their 

development and operation, it is critical 

that the Secretary work closely with 

States to provide necessary guidance 

and technical assistance to ensure that 

States can meet the prescribed 

timelines, federal requirements, and 

goals of the statute and the grants 

awarded to them. Form Number: CMS– 

10371 (OMB control number: 0938– 

1119); Frequency: Once; Affected 

Public: State Government agencies, 

Private sector (Not-for-profit 

institutions); Number of Respondents: 

28; Number of Responses: 48; Total 

Annual Hours: 31,404. (For policy 

questions regarding this collection, 

contact Dena Puskin at (301) 492–4342.) 

4. Type of Information Collection 

Request: Revision of a previously 

approved information collection; Title 

of Information Collection: Exchange 

Functions: Standards for Navigators and 

Non-Navigator Assistance Personnel; 

Use: Section 1321(a)(1) of the Affordable 

Care Act directs and authorizes the 

Secretary to issue regulations setting 

standards for meeting the requirements 

under title I of the Affordable Care Act, 

with respect to, among other things, the 

establishment and operation of 

Exchanges. Pursuant to this authority, 

regulations have been finalized at 45 

CFR 155.215(b)(1) to require Navigators, 

as well as those non-Navigator 

personnel to whom 45 CFR 155.215 

applies, requires completion of HHS 

approved training for initial certification 

and annual recertification prior to 

providing application and enrollment 

assistance. The training will include an 

optional training quality survey 

providing Navigators and non-Navigator 

assistance personnel to whom 45 CFR 

155.215 applies, an opportunity to 

provide feedback to CMS regarding the 

training and any improvements that can 

be made in the future. Form Number: 

CMS–10472 (OMB control number. 

0938–1220); Frequency: On Occasion; 

Affected Public: State, Local, or Tribal 

Governments, Private sector (Not-forprofit institutions), Individuals or 

Households; Number of Respondents: 

5,610; Number of Responses: 5,610; 

Total Annual Hours: 37,036. (For policy 

questions regarding this collection, 

contact Heather Raeburn at 301–492– 

4224.) 

5. Type of Information Collection 

Request: Revision of a previously 

approved information collection; Title 

of Information Collection: Patient 

Protection and Affordable Care Act; 

Consumer Assistance Tools and 

Programs of an Exchange and Certified 

Application Counselors; Exchange and 

Insurance Market Standards for 2015; 

Use: Section 1321(a)(1) of the Affordable 

Care Act directs and authorizes the 

Secretary to issue regulations setting 

standards for meeting the requirements 

under title I of the Affordable Care Act, 

with respect to, among other things, the 

establishment and operation of 

Exchanges. Pursuant to this authority, 

regulations establishing the certified 

application counselor program have 

been finalized at 45 CFR 155.225. In 

accordance with 155.225(d)(1) and (7), 

certified application counselors in all 

Exchanges are required to be initially 

certified and recertified on at least an 

annual basis and successfully complete 

Exchange-required training. Form 

Number: CMS–10494 (OMB control 

number: 0938–1205); Frequency: On 

Occasion; Affected Public: State, Local, 

or Tribal Governments, Private sector 

(Not-for-profit institutions), Individuals 

or Households; Number of Respondents: 

35,000; Number of Responses: 190,000; 

Total Annual Hours: 27,110. (For policy 

questions regarding this collection, 

contact Tricia Beckmann at 301–492– 

4328.) 

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Federal Register / Vol. 80, No. 75 / Monday, April 20, 2015 / Notices 21723 

Dated: April 15, 2015. 

William N. Parham, III, 

Director, Paperwork Reduction Staff, Office 

of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2015–09009 Filed 4–17–15; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Community Living 

Applications for New Awards; National 

Institute on Disability, Independent 

Living, and Rehabilitation Research— 

Rehabilitation Research and Training 

Centers 

AGENCY: Administration for Community 

Living, Department of Health and 

Human Services. 

ACTION: Notice. 

Overview Information: National 

Institute on Disability, Independent 

Living, and Rehabilitation Research 

(NIDILRR)—Rehabilitation Research and 

Training Centers (RRTC)—Employer 

Practices Leading to Successful 

Employment Outcomes for Individuals 

with Disabilities. 

Notice inviting applications for new 

awards for fiscal year (FY) 2015. 

Catalog of Federal Domestic Assistance 

(CFDA) Number: 84.133B–1. 

DATES: Applications Available: April 20, 

2015. 

Note: On July 22, 2014, President Obama 

signed the Workforce Innovation 

Opportunity Act (WIOA). WIOA was 

effective immediately. One provision of 

WIOA transferred the National Institute on 

Disability and Rehabilitation Research 

(NIDRR) from the Department of Education to 

the Administration for Community Living 

(ACL) in the Department of Health and 

Human Services. In addition, NIDRR’s name 

was changed to the Institute on Disability, 

Independent Living, and Rehabilitation 

Research (NIDILRR). For FY 2015, all 

NIDILRR priority notices will be published as 

ACL notices, and ACL will make all NIDILRR 

awards. During this transition period, 

however, NIDILRR will continue to review 

grant applications using Department of 

Education tools. NIDILRR will post 

previously-approved application kits to 

grants.gov, and NIDILRR applications 

submitted to grants.gov will be forwarded to 

the Department of Education’s G–5 system 

for peer review. We are using Department of 

Education application kits and peer review 

systems during this transition year in order 

to provide for a smooth and orderly process 

for our applicants. 

Date of Pre-Application Meeting: May 11, 

2015. 

Deadline for Notice of Intent to 

Apply: May 26, 2015. 

Deadline for Transmittal of 

Applications: June 19, 2015. 

Full Text of Announcement 

I. Funding Opportunity Description 

Purpose of Program: The purpose of 

the Disability and Rehabilitation 

Research Projects and Centers Program 

is to plan and conduct research, 

demonstration projects, training, and 

related activities, including 

international activities to develop 

methods, procedures, and rehabilitation 

technology. The Program’s activities are 

designed to maximize the full inclusion 

and integration into society, 

employment, independent living, family 

support, and economic and social selfsufficiency of individuals with 

disabilities, especially individuals with 

the most severe disabilities, and to 

improve the effectiveness of services 

authorized under the Rehabilitation Act 

of 1973, as amended (Rehabilitation 

Act). 

Rehabilitation Research and Training 

Centers 

The purpose of the RRTCs, which are 

funded through the Disability and 

Rehabilitation Research Projects and 

Centers Program, is to achieve the goals 

of, and improve the effectiveness of, 

services authorized under the 

Rehabilitation Act through welldesigned research, training, technical 

assistance, and dissemination activities 

in important topical areas as specified 

by NIDILRR. These activities are 

designed to benefit rehabilitation 

service providers, individuals with 

disabilities, family members, 

policymakers and other research 

stakeholders. Additional information on 

the RRTC program can be found at: 

http://www2.ed.gov/programs/rrtc/

index.html#types. 

Priorities: There are two priorities for 

the grant competition announced in this 

notice. The General RRTC Requirements 

priority is from the notice of final 

priorities for the Rehabilitation Research 

and Training Centers, published in the 

Federal Register on February 1, 2008 

(73 FR 6132). Priority two is from the 

notice of final priority for this program, 

published elsewhere in this issue of the 

Federal Register. 

Absolute Priorities: For FY 2015 and 

any subsequent year in which we make 

awards from the list of unfunded 

applicants from this competition, these 

priorities are absolute priorities. Under 

45 CFR part 75 we consider only 

applications that meet these program 

priorities. 

These priorities are: 

Priority 1—General RRTC 

Requirements. 

Note: The full text of this priority is 

included in the notice of final priorities for 

the Rehabilitation Research and Training 

Centers, published in the Federal Register on 

February 1, 2008 (73 FR 6132) and in the 

application package for this competition. 

Priority 2—RRTC on Employer 

Practices Leading to Successful 

Employment Outcomes for Individuals 

with Disabilities. 

Note: The full text of this priority is 

included in the notice of final priority 

published elsewhere in this issue of the 

Federal Register and in the application 

package for this competition. 

Program Authority: 29 U.S.C. 762(g) and 

764(b)(2). 

Applicable Regulations: (a) The 

Department of Health and Human 

Services General Administrative 

Regulations in 45 CFR part 75; (b) Audit 

Requirements for Federal Awards in 45 

CFR part 75 Subpart F; (c) 45 CFR part 

75 Non-procurement Debarment and 

Suspension; (d) 45 CFR part 75 

Requirement for Drug-Free Workplace 

(Financial Assistance); (e) The 

regulations for this program in 34 CFR 

part 350; (f) The notice of final priorities 

for the RRTC Program published in the 

Federal Register on February 1, 2008 

(73 FR 6132); and (g) The notice of final 

priority for this program, published 

elsewhere in this issue of the Federal 

Register. 

II. Award Information 

Type of Award: Discretionary grants. 

Estimated Available Funds: $875,000. 

Contingent upon the availability of 

funds and the quality of applications, 

we may make additional awards in FY 

2015 and any subsequent year from the 

list of unfunded applicants from this 

competition. 

Maximum Award: $875,000. 

We will reject any application that 

proposes a budget exceeding the 

Maximum Amount for a single budget 

period of 12 months. The Administrator 

of the Administration for Community 

Living may change the maximum 

amount through a notice published in 

the Federal Register. 

Estimated Number of Awards: 1. 

The Department is not bound by any 

estimates in this notice. 

Project Period: 60 months. 

We will reject any application that 

proposes a project period exceeding 60 

months. The Administrator of the 

Administration for Community Living 

may change the project period through 

a notice published in the Federal 

Register. 

III. Eligibility Information 

1. Eligible Applicants: States; public 

or private agencies, including for-profit 

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