Federal Register / Vol. 78, No. 65 / Thursday, April 4, 2013 / Notices 20323 

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: March 29, 2013. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2013–07798 Filed 4–3–13; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers: CMS–10309, CMS– 

10475, CMS–R–5, CMS–R–234, and CMS– 

R–297] 

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: Reinstatement with change of a 

previously approved collection. Title of 

Information Collection: Grandfathering 

Provisions of the Medicare DMEPOS 

Competitive Bidding Program. Use: 

Section 1847(a)(4) of the Social Security 

Act (the Act) requires that (in the case 

of covered durable medical equipment 

(DME) items for which payment is made 

on a rental basis under section 1834(a) 

of the Act and in the case of oxygen for 

which payment is made under section 

1834(a)(5) of the Act) the Secretary shall 

establish a grandfathering process by 

which covered items and supplies that 

were rented by suppliers before the 

implementation of a competitive 

bidding program may be continued. 

We established the grandfathering 

process in the April 10, 2007 final rule 

for competitive bidding (72 FR 17992) 

for rented DME and oxygen and oxygen 

equipment when these items are 

included under the Medicare DMEPOS 

Competitive Bidding Program. This 

process only applies to suppliers that 

rented DME and oxygen and oxygen 

equipment to beneficiaries who 

maintain a permanent residence in a 

competitive bidding area (CBA) before 

the implementation of the competitive 

bidding program. 

The competitive bidding program will 

require some beneficiaries to change 

their suppliers. In order to avoid a 

beneficiary being without medically 

necessary equipment we felt it 

necessary to establish this notification 

process. 

The notification to the beneficiaries is 

a beneficiary protection that will keep 

them informed of whether or not they 

can continue to rent an item from their 

current supplier or go to a contract 

supplier. The notification will also 

provide information to the beneficiary 

as to how to find a contract supplier in 

their CBA. In the event that the 

beneficiary must go to a contract 

supplier, the notification will identify 

the procedure for the pick-up of their 

current equipment and delivery of new 

equipment. 

Form Number: CMS–10309 (OCN 

0938–1079). Frequency: Once. Affected 

Public: Private sector (business or other 

for-profits). Number of Respondents: 

2,697 (or 8,091/3). Total Annual 

Responses: 536,667 (or 1,610,000/3). 

Total Annual Hours: 65 (or 196/3). (For 

policy questions regarding this 

collection contact Michael Keane at 

410–786–4495. For all other issues call 

410–786–1326.) 

2. Type of Information Collection 

Request: New collection (request for a 

new OMB control number). Title of 

Information Collection: Hospice 

Experience of Care Survey. Use: This 

survey supports the National Quality 

Strategy that was called for under the 

Affordable Care Act to create national 

aims and priorities to guide local, state, 

and national efforts to improve the 

quality of health care. This strategy has 

established six priorities that support a 

three-part aim focusing on better care, 

better health, and lower costs through 

improvement. Because the hospice 

survey focuses on experiences of care, 

implementation of the survey supports 

the following national priorities for 

improving care: engaging patients and 

families in care and promoting effective 

communication and coordination. In 

addition, upon national implementation 

and public reporting of hospice survey 

results, the survey will provide data on 

experiences with hospice care that 

enable consumers to make meaningful 

comparisons between hospices across 

the nation. Form Number: CMS–10475 

(OCN 0938–New). Frequency: Once. 

Affected Public: Individuals and 

households. Number of Respondents: 

730. Total Annual Responses: 730. Total 

Annual Hours: 185. (For policy 

questions regarding this collection 

contact Lori Teichman at 410–786– 

6684. For all other issues call 410–786– 

1326.) 

3. Type of Information Collection 

Request: Reinstatement without change 

of a previously approved collection. 

Title of Information Collection: 

Physician Certification/Recertification 

in Skilled Nursing Facilities (SNFs) 

Manual Instructions and Supporting 

Regulation in 42 CFR 424.20. Use: The 

Medicare program requires, as a 

condition for Medicare Part A payment 

for posthospital SNF services that a 

physician must certify and periodically 

recertify that a beneficiary requires an 

SNF level of care. The physician 

certification and recertification is 

intended to ensure that the beneficiary’s 

need for services has been established 

and then reviewed and updated at 

appropriate intervals. The 

documentation is a condition for 

Medicare Part A payment for posthospital SNF care. Form Number: CMS– 

R–5 (OCN 0938–0454). Frequency: 

Occasionally. Affected Public: Private 

sector (business or other for-profit and 

not-for-profit institutions). Number of 

Respondents: 1,796,502. Total Annual 

Responses: 1,796,502. Total Annual 

Hours: 559,713. (For policy questions 

regarding this collection contact Kia 

Sidbury at 410–786–7816. For all other 

issues call 410–786–1326.) 

4. Type of Information Collection 

Request: Extension without change of a 

currently approved collection. Title of 

Information Collection: Subpart D— 

Private Contracts and Supporting 

Regulations contained in 42 CFR 

405.410, 405.430, 405.435, 405.440, 

405.445, and 405.455. Use: Section 4507 

of Balancing Budget Act (BBA) 1997 

amended section 1802 of the Social 

Security Act to permit certain 

physicians and practitioners to opt-out 

of Medicare and to provide (through 

private contracts) services that would 

otherwise be covered by Medicare. 

Under such contracts the mandatory 

claims submission and limiting charge 


wreier-aviles on DSK5TPTVN1PROD with NOTICES
20324 Federal Register / Vol. 78, No. 65 / Thursday, April 4, 2013 / Notices 

rules of section 1848(g) of the Act would 

not apply. Subpart D and the supporting 

regulations counter the effect of certain 

provisions of Medicare law that, absent 

section 4507 of BBA 1997, preclude 

physicians and practitioners from 

contracting privately with Medicare 

beneficiaries to pay without regard to 

Medicare limits. Physicians and/or 

practitioners use these information 

collection requirements to comply with 

the law. In addition, Medicare carriers 

use this information to determine if 

benefits should be paid or continued. 

Form Number: CMS–R–234 (OCN 0938– 

0730). Frequency: Biennially. Affected 

Public: Private sector (business or other 

for-profits). Number of Respondents: 

26,820. Total Annual Responses: 

26,820. Total Annual Hours: 7,197. (For 

policy questions regarding this 

collection contact Fred Grabau at 410– 

786–0206. For all other issues call 410– 

786–1326.) 

5. Type of Information Collection 

Request: Extension without change of a 

currently approved collection. Title of 

Information Collection: Request for 

Employment Information. Use: This 

form is used by the Social Security 

Administration to obtain information 

from employers regarding whether a 

Medicare beneficiary’s coverage under a 

group health plan is based on current 

employment status. Form Number: 

CMS–R–297 (OCN 0938–0787). 

Frequency: Once. Affected Public: 

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

Number of Respondents: 15,000. Total 

Annual Responses: 15,000. Total 

Annual Hours: 3,750. (For policy 

questions regarding this collection 

contact Lindsay Smith at 410–786–6843. 

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 3, 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 llllllll, 

Room C4–26–05, 7500 Security 

Boulevard, Baltimore, Maryland 21244– 

1850. 

Dated: March 29, 2013. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2013–07800 Filed 4–3–13; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity: Comment Request 

Title: Innovative Strategies for 

Increasing Self-Sufficiency: Follow-Up 

Data Collection. 

OMB No.: 0970–0397. 

Description: The Administration for 

Children and Families (ACF), U.S. 

Department of Health and Human 

Services (HHS), is proposing a data 

collection activity as part of the 

Innovative Strategies for Increasing SelfSufficiency (ISIS) demonstration and 

evaluation. The ISIS project will test a 

range of promising career pathways 

strategies to promote education, 

employment, and self-sufficiency. The 

major goals of the ISIS project include 

increasing the empirical knowledge 

about the effectiveness of a variety of 

programs for low-income individuals 

and families to achieve educational 

credentials, attain employment and 

advance to positions that enable selfsufficiency, as well as producing useful 

findings for both policymakers and 

program administrators. 

This proposed information collection 

activity focuses on collecting follow-up 

data elements approximately fifteen 

months after program enrollment. 

Baseline data collection instruments 

were previously approved under OMB 

No. 0970–0397. 

The purpose of this information 

collection effort is to follow-up with 

study participants, document the 

experiences of program participants, 

examine differences in service receipt 

and educational experiences between 

program and control group members, 

describe the intervention as it was 

implemented in each site and assess the 

extent to which it was implemented as 

intended, and assess the implications 

for intervention scalability and 

sustainability. 

Specifically, this data will be 

collected using the following 

instruments: (a) A follow-up survey 

which will be administered to all study 

participants approximately 15 months 

following enrollment in the study; (b) a 

modification to the Baseline Information 

Form requesting some basic information 

about all of the study participant’s 

children (if applicable); (c) interview 

guides for the in-person visits to the 

intervention sites to structure 

discussions with program leadership/ 

managers, instructional staff, case 

managers/advisors, partners and 

employers; (d) a brief survey for 

instructional staff; (e) a brief survey for 

case managers/advisors; (f) a brief study 

participant check-in call; and (g) indepth interviews with a sample of study 

participants. Respondents: Individuals 

enrolled in the ISIS demonstration 

programs, control group members, ISIS 

program/partner staff (including 

program leadership, case managers and 

instructional staff), and other local 

informants. 

ANNUAL BURDEN ESTIMATES

Instrument Total number 

of respondents 

Number of responses per 

respondent 

Average burden hours per 

response 

Total burden 

hours 

Average annual burden 

hours 

#1 Basic Information Form Modification .............................. 5,645 1 0.05 282 94 

#2 15 Month Follow-up Survey, no child roster .................. 6,998 1 0.833 5,829 1943 

#2 15 Month Follow-up Survey, with child roster ................ 1,562 1 1 1,562 521 

#2 15 Month Follow-Up Survey, Additional HPOG Questions .................................................................................. 2,974 1 0.083 247 82 


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