Federal Register / Vol. 79, No. 12 / Friday, January 17, 2014 / Notices 3207 

ESTIMATED ANNUALIZED BURDEN HOURS

Type of 

respondents Form name Number of respondents 

Number of 

responses per 

respondent 

Average 

burden per 

response 

(in hrs.) 

Local health departments ....... Evaluation Survey (electronic) ............................................... 138 1 2 

Evaluation Survey (paper-based) ........................................... 35 1 2 

State health departments ....... Evaluation Survey (electronic) ............................................... 14 1 2 

Evaluation Survey (paper-based) ........................................... 3 1 2 

LeRoy 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. 2014–00911 Filed 1–16–14; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers: CMS–10396 and 

CMS–10462] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, HHS. 

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 

March 18, 2014. 

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 ll, 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–10396 Medication Therapy 

Management Program Improvements 

CMS–10462 Community First Choice 

Option 

Under the Paperwork Reduction Act 

(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 Collections 

1. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Medication 

Therapy Management Program 

Improvements; Use: Information 

collected by Part D medication therapy 

management programs (as required by 

the standardized format for the 

comprehensive medication review 

summary) will be used by beneficiaries 

or their authorized representatives, 

caregivers, and their healthcare 

providers to improve medication use 

and achieve better healthcare outcomes. 

Form Number: CMS–10396 (OCN: 

0938–1154); Frequency: Occasionally; 

Affected Public: Private sector (business 

or other for-profits); Number of 

Respondents: 682; Total Annual 

Responses: 280,352; Total Annual 

Hours: 163,539. (For policy questions 

regarding this collection contact Gary 

Wirth at 410–786–3977). 

2. Type of Information Collection 

Request: New collection (request for a 

new OMB control number); Title of 


emcdonald on DSK67QTVN1PROD with NOTICES
3208 Federal Register / Vol. 79, No. 12 / Friday, January 17, 2014 / Notices 

Information Collection: Community 

First Choice Option; Use: This project is 

an evaluation of the implementation 

and progress of the Community First 

Choice (CFC) Option. The results of the 

study will be included in the final 

Report to Congress, to be delivered by 

the Secretary of Health and Human 

Services in 2015. The project is 

designed to assist CMS and Congress in 

their understanding of: States’ CFC 

implementation plans, the effectiveness 

of the CFC Option on individuals 

receiving home- and community-based 

attendant care, and States’ spending on 

long-term services and supports. 

Researchers will request data from 

States approved for CFC via a data form 

and semi-structured interviews. 

Information obtained will be used to 

better understand CFC program design, 

the targeted patient population, and 

intended outcomes. At this time, we 

have only approved California’s 

program. To provide comparative 

information to the Secretary, researchers 

will also collect data from States that 

have decided not to pursue the CFC 

option. Data will be analyzed and 

developed into a report to Congress 

which will evaluate the effectiveness of 

the CFC option, the program’s impact on 

participants’ physical and emotional 

health, and a comparative analysis of 

the costs of community-based services 

and those provided in institutional 

settings. Form Number: CMS–10462 

(OCN: 0938—New); Frequency: Once; 

Affected Public: Individuals and 

households, private sector (business or 

other for-profits and not-for-profit 

institutions), and State, Local, or Tribal 

Governments; Number of Respondents: 

108; Total Annual Responses: 126; Total 

Annual Hours: 225. (For policy 

questions regarding this collection 

contact Elizabeth Garbarczyk at 410– 

786–0426). 

Dated: January 14, 2014. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2014–00916 Filed 1–16–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers: CMS–1561, CMS–R– 

216, and CMS–R–262] 

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 February 18, 2014: 

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/

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: 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: Extension of a currently 

approved collection; Title of 

Information Collection: Health 

Insurance Benefit Agreement; Use: 

Applicants to the Medicare program are 

required to agree to provide services in 

accordance with federal requirements. 

The CMS–1561 is essential in that is 

allows us to ensure that applicants are 

in compliance with the requirements. 

Applicants will be required to sign the 

completed form and provide operational 

information to us to assure that they 

continue to meet the requirements after 

approval. Form Number: CMS–1561 

(OCN: 0938–0832); Frequency: Yearly; 

Affected Public: Private sector— 

(Business or other for-profits and Notfor-profit institutions); Number of 

Respondents: 3,000; Total Annual 

Responses: 3,000; Total Annual Hours: 

500. (For policy questions regarding this 

collection contact Shonte Carter at 410– 

786–3532). 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Procedures for 

Advisory Opinions Concerning 

Physicians’ Referrals and Supporting 

Regulations; Use: The information 

collection requirements contained in 42 

CFR 411.372 and 411.373 allow us to 

consider requests for advisory opinions 


emcdonald on DSK67QTVN1PROD with NOTICES