6726 Federal Register / Vol. 80, No. 25 / Friday, February 6, 2015 / Notices 

CDC and the evaluation contractor 

will use the Internet usage data and the 

survey information collected from study 

participants to examine the statistical 

relationships between confirmed 

exposure (or non-exposure) to the 

campaign’s digital and social media 

advertising and outcomes of interest for 

campaign evaluation. The study will 

provide CDC with new, timely, and 

relevant information regarding the reach 

and efficacy of the digital advertising 

component of the campaign in 2015. All 

findings will be interpreted in light of 

known limitations of the methodology, 

such as use of a convenience sample of 

respondents. 

OMB approval is requested for one 

year. Participation is voluntary and 

there are no costs to respondents other 

than their time. 

ESTIMATED ANNUALIZED BURDEN HOURS

Type of respondent Form name Number of 

respondents 

Number of 

responses per 

respondent 

Average 

burden per 

response 

(in hours) 

Total burden 

(in hours) 

Market Research Panelists ............... Screening and Consent Questionnaire.50,000 1 2/60 1,667 

Adult Panelists Who Are Tobacco 

Smokers.

Digital Media and Tobacco Outcomes Questionnaire (Wave 1).5,000 1 20/60 1,667 

Digital Media and Tobacco Outcomes Questionnaire (Wave 2).2,400 1 20/60 800 

Total ........................................... ........................................................... ........................ ........................ ........................ 4,134 

Leroy A. Richardson, 

Chief, Information Collection Review Office, 

Office of Scientific Integrity, Office of the 

Associate Director for Science, Office of the 

Director, Centers for Disease Control and 

Prevention. 

[FR Doc. 2015–02327 Filed 2–5–15; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers CMS–10410, CMS–R– 

74, CMS–2552–10 and CMS–855R] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services. 

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 (the 

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 

60 days for public comment on the 

proposed action. Interested persons are 

invited to send comments regarding our 

burden estimates 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 must be received by 

April 7, 2015. 

ADDRESSES: When commenting, please 

reference the document identifier or 

OMB control number (OCN). To be 

assured consideration, comments and 

recommendations must be submitted in 

any one of the following ways: 

1. Electronically. You may send 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) that are 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 llllll, Room 

C4–26–05, 7500 Security Boulevard, 

Baltimore, Maryland 21244–1850. 

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/

PaperworkReductionActof1995. 

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: 

Contents 

This notice sets out a summary of the 

use and burden associated with the 

following information collections. More 

detailed information can be found in 

each collection’s supporting statement 

and associated materials (see 

ADDRESSES). 

CMS–10410 Medicaid Program; Eligibility 

Changes under the Affordable Care Act 

of 2010 

CMS–R–74 Income and Eligibility 

Verification System Reporting and 

Supporting Regulations 

CMS–2552–10 Hospital and Hospital 

Health Care Complex Cost Report 

CMS–855R Medicare Enrollment 

Application: Reassignment of Medicare 

Benefits 

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 


asabaliauskas on DSK5VPTVN1PROD with NOTICES
Federal Register / Vol. 80, No. 25 / Friday, February 6, 2015 / Notices 6727 

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 

Program; Eligibility Changes under the 

Affordable Care Act of 2010; Use: The 

eligibility systems are essential to the 

goal of increasing coverage in insurance 

affordability programs while reducing 

administrative burden on states and 

consumers. The electronic transmission 

and automation of data transfers are key 

elements in managing the expected 

insurance affordability program 

caseload that started in 2014. 

Accomplishing the same work without 

these information collection 

requirements would not be feasible. 

Form Number: CMS–10410 (OMB 

control number 0938–1147); Frequency: 

Occasionally; Affected Public: 

Individuals or households, and State, 

Local, and Tribal Governments; Number 

of Respondents: 25,500,096; Total 

Annual Responses: 76,500,149; Total 

Annual Hours: 21,278,142. (For policy 

questions regarding this collection 

contact Brenda Sheppard at 410–786– 

8534). 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Income and 

Eligibility Verification System Reporting 

and Supporting Regulations; Use: A 

state Medicaid agency that currently 

obtains and uses information from 

certain sources, or with more frequency 

than specified, could continue to do so 

to the extent that the verifications are 

useful and not redundant. An agency 

that has found it effective to verify all 

wage or benefit information with 

another agency or with the recipient is 

encouraged to continue these practices 

if it chooses. On the other hand, the 

agency may implement an approved 

targeting plan under 42 CFR 435.953. 

The agency’s experience should guide 

its decision whether to exceed these 

regulatory requirements on income and 

eligibility verification. While states may 

target resources when verifying income 

of course, agencies are still held 

accountable for their accuracy in 

eligibility determinations. Form 

Number: CMS–R–74 (OMB control 

number 0938–0467); Frequency: 

Occasionally; Affected Public: State, 

Local, or Tribal Governments; Number 

of Respondents: 50; Total Annual 

Responses: 71; Total Annual Hours: 

134,865. (For policy questions regarding 

this collection contact Brenda Sheppard 

at 410–786–8534). 

3. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Hospital and 

Hospital Health Care Complex Cost 

Report; Use: Providers of services 

participating in the Medicare program 

are required under sections 1815(a) and 

1861(v)(1)(A) of the Social Security Act 

(42 U.S.C. 1395g) to submit annual 

information to achieve settlement of 

costs for health care services rendered to 

Medicare beneficiaries. In addition, 

regulations at 42 CFR 413.20 and 413.24 

require adequate cost data and cost 

reports from providers on an annual 

basis. 

We are requesting the Office of 

Management and Budget review and 

approve this revision to the Form CMS– 

2552–10, Hospital and Hospital Health 

Care Complex Cost Report. These cost 

reports are filed annually by hospitals 

participating in the Medicare program to 

determine the reasonable costs incurred 

to provide medical services to patients. 

The revisions made to the hospital cost 

report are in accordance with the 

statutory requirement for hospice 

payment reform in § 3132 of the Patient 

Protection and Affordable Care Act 

(ACA) (March 23, 2010) and the 

statutory requirement establishing a 

prospective payment system for 

Federally Qualified Health Centers in 

§ 10501(i)(3)(A) of the ACA, codified in 

section 1834(o) of the Act. Form 

Number: CMS–2552–10 (OMB control 

number 0938–0050); Frequency: Yearly; 

Affected Public: State, Local, or Tribal 

Governments, private sector (for-profit 

and not-for-profit institutions); Number 

of Respondents: 6,157; Total Annual 

Responses: 6,157; Total Annual Hours: 

4,143,661. (For policy questions 

regarding this collection contact Gail 

Duncan at 410–786–7278). 

4. 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 

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 410–786–5374). 

Dated: February 3, 2015. 

William N. Parham, III, 

Director, Paperwork Reduction Staff, Office 

of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2015–02414 Filed 2–5–15; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Community Living 

Administration on Intellectual and 

Developmental Disabilities (AIDD); 

Notice of Meeting 

AGENCY: President’s Committee for 

People with Intellectual Disabilities 

(PCPID). 


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