41140 Federal Register / Vol. 74, No. 156 / Friday, August 14, 2009 / Notices 

Proposed Project: Applicant 

Background Survey—OMB No. 0990– 

0208- Extension- Assistant Secretary for 

Administration and Management. 

Abstract: The Applicant Background 

Survey form will be used for the next 

three years by the Operating Divisions 

(OPDIVs). The major sub-organizations 

within the Department of Health and 

Human Services (HHS), will collect and 

analyze data on race, sex, national 

origin, and disability from applicants for 

employment. Information will be 

collected by each of the personnel 

offices in the Department. The form will 

be used routinely by the OPDIVs when 

recruiting for all positions, including 

senior level positions and for selected 

job series where workforce analysis has 

shown evidence of low representation of 

minorities, women, or persons with 

disabilities. The results of the collection 

will assist the Department to determine 

if present recruitment sources yield 

qualified minority and female 

applicants and applicants with 

disabilities as required by EEOC MD 

715. 

ESTIMATED ANNUALIZED BURDEN TABLE

Type of respondent Number of 

respondents 

Number of 

responses per 

respondent 

Average burden hours per response Total burden 

hours 

Individuals ....................................................... 30,000 1 2 minutes ........................................................ 1,000 

Seleda Perryman, 

Office of the Secretary, Paperwork Reduction 

Act Reports Clearance Officer. 

[FR Doc. E9–19513 Filed 8–13–09; 8:45 am] 

BILLING CODE 4151–17–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

[Document Identifier: OS–0990–; 30-Day 

Notice] 

Agency Information Collection 

Request; 30–Day Public Comment 

Request 

AGENCY: Office of the Secretary, HHS. 

In compliance with the requirement 

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

Paperwork Reduction Act of 1995, the 

Office of the Secretary (OS), Department 

of Health and Human Services, is 

publishing the following summary of a 

proposed collection 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. 

To obtain copies of the supporting 

statement and any related forms for the 

proposed paperwork collections 

referenced above, e-mail your request, 

including your address, phone number, 

OMB number, and OS document 

identifier, to Sherette.funncoleman@

hhs.gov, or call the Reports Clearance 

Office at (202) 690–5683. Send written 

comments and recommendations for the 

proposed information collections within 

30 days of this notice directly to the OS 

OMB Desk Officer; faxed to OMB at 

202–395–5806. 

Proposed Project: Evaluate the 

Advancing Systems Improvements to 

Support Targets for Healthy People 2010 

(ASIST2010) Program—OMB No. 0990– 

NEW—Office on Women’s Health. 

Abstract: The Office on Women’s 

Health is collecting data from 13 funded 

grantees and clients participating in 

ASIST2010, a three-year, cooperative 

agreement program. ASIST2010 uses a 

public health systems approach to 

improve performance on two or more of 

seven Healthy People 2010 (HP 2010) 

objectives that target women and/or 

men in six focus areas—cancer, 

diabetes, heart disease and stroke, 

access to quality health services, 

educational and community-based 

programs, nutrition and overweight, and 

physical activity and fitness. The goals 

of the ASIST2010 program are to: (1) 

Provide additional support to existing 

public health systems/collaborative 

partnerships to enable them to add a 

gender focus to HP 2010 objectives that 

track the health status of women and/or 

men, to help improve gender outcome 

in the targeted population and/or 

geographic area; (2) improve 

surveillance/information systems that 

allow tracking of program progress on 

HP 2010 objectives at the grantee level; 

and (3) develop and implement a plan 

to sustain the program after OWH 

funding ends. The sites participating in 

the ASIST2010 program represent four 

academic medical centers, three 

community-based organizations, two 

hospitals, two state health departments, 

one county health department, and one 

foundation. 

ESTIMATED ANNUALIZED BURDEN HOURS

Type of respondent Form name Number of 

respondents 

Number of 

responses per 

respondent 

Avg. burden 

per response 

(in hours) 

Total burden 

(in hours) 

Grantee Staff ..................................... Grantee Telephone Interview Protocol (Round 1).65 3 1 195 

Site Visit Advance Letter.

Site Visit Protocol.

Grantee Telephone Interview Protocol (Round 2).

Partner Organization Staff (In-person 

interviews).

Site Visit Protocol ............................. 52 1 1 52 

Consumers (In-person interviews) .... Site Visit Protocol ............................. 18 1 1 18 

Consumers (Focus groups) .............. Focus Group Advance Letter ........... 40 1 1.5 60 

Focus Group Flyer.

mstockstill on DSKH9S0YB1PROD with NOTICES

Federal Register / Vol. 74, No. 156 / Friday, August 14, 2009 / Notices 41141 

ESTIMATED ANNUALIZED BURDEN HOURS—Continued 

Type of respondent Form name Number of 

respondents 

Number of 

responses per 

respondent 

Avg. burden 

per response 

(in hours) 

Total burden 

(in hours) 

Consumer Focus Group Discussion 

Guide.

Comparison Organization Staff 

(Telephone Interviews).

10 ..................................................... 1 1 10 Advance 

Letter for 

Comparison 

Organizations 

Comparison Organization Interview 

Protocol.

Total ........................................... ........................................................... ........................ ........................ ........................ 335 

Seleda Perryman, 

Office of the Secretary, Paperwork Reduction 

Act Reports Clearance Officer. 

[FR Doc. E9–19515 Filed 8–13–09; 8:45 am] 

BILLING CODE 4150–33–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10050, CMS– 

1450(UB–04), CMS–276 and CMS–R–254] 

Agency Information Collection 

Activities: Submission for OMB 

Review; 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), 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 function; 

(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: Revision of the currently 

approved collection; Title of 

Information Collection: New Enrollee 

Survey; Use: The New Enrollee survey 

was developed to gather information 

from newly enrolled Medicare 

beneficiaries about their Medicare 

knowledge and needs. CMS is seeking 

understanding about what types of 

information new enrollees need and 

what they know about Medicare. 

Included in the survey are questions 

regarding how well informed new 

enrollees are about Medicare and what 

information they have received about 

the Medicare program. Information 

gathered in this survey will be used 

only for purposes of targeting and 

improving communications with newly 

eligible Medicare beneficiaries. Form 

Number: CMS–10050 (OMB#: 0938– 

0869); Frequency: Reporting—Quarterly; 

Affected Public: Individuals or 

Households; Number of Respondents: 

1200; Total Annual Responses: 1200; 

Total Annual Hours: 300. (For policy 

questions regarding this collection 

contact Renee Clarke at 410–786–0006. 

For all other issues call 410–786–1326.) 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Medicare 

Uniform Institutional Provider Bill and 

Supporting Regulations in 42 CFR 

424.5; Use: Section 42 CFR 424.5(a)(5) 

requires providers of services to submit 

a claim for payment prior to any 

Medicare reimbursement. Charges billed 

are coded by revenue codes. The bill 

specifies diagnoses according to the 

International Classification of Diseases, 

Ninth Edition (ICD–9–CM) code. 

Inpatient procedures are identified by 

ICD–9–CM codes, and outpatient 

procedures are described using the CMS 

Common Procedure Coding System 

(HCPCS). These are standard systems of 

identification for all major health 

insurance claims payers. Submission of 

information on the CMS–1450 permits 

Medicare intermediaries to receive 

consistent data for proper payment. 

Form Numbers: CMS–1450 (UB– 

04)(OMB#: 0938–0997); Frequency: 

Reporting—On occasion; Affected 

Public: Not-for-profit institutions, 

Business or other for-profit; Number of 

Respondents: 53,111; Total Annual 

Responses: 181,909,654; Total Annual 

Hours: 1,567,455. (For policy questions 

regarding this collection contact Matt 

Klischer at 410–786–7488. For all other 

issues call 410–786–1326.) 

3. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Prepaid Health 

Plan Cost Report; Use: Health 

Maintenance Organizations and 

Competitive Medical Plans (HMO/ 

CMPs) contracting with the Secretary 

under Section 1876 of the Social 

Security Act are required to submit a 

budget and enrollment forecast, four 

quarterly reports and a final certified 

cost report. Health Care Prepayment 

Plans (HCPPs) contracting with the 

Secretary under Section 1833 of the 

Social Security Act are required to 

submit a budget and enrollment 

forecast, mid-year report, and final cost 

report. An HMO/CMP is a health care 

delivery system that furnishes directly 

or arranges for the delivery of the full 

spectrum of health services to an 

enrolled population. A HCPP is a health 

care delivery system that furnishes 

directly or arranges for the delivery of 

certain physician and diagnostics 

services up to the full spectrum of nonprovider Part B health services to an 

enrolled population. These reports will 

be used to establish the reasonable cost 

of delivering covered services furnished 

to Medicare enrollees by an HMO/CMP 

or HCPP.; Form Numbers: CMS–276 

(OMB#: 0938–0165); Frequency: 

Recordkeeping, Reporting—Quarterly 

and Annually; Affected Public: Business 

or other for-profit; Number of 

Respondents: 35; Total Annual 

Responses: 128; Total Annual Hours: 

5,285. (For policy questions regarding 

this collection contact Temeshia 

Johnson at 410–786–8692. For all other 

issues call 410–786–1326.) 

4. Type of Information Collection 

Request: Reinstatement of a currently 

approved collection; Title of 

mstockstill on DSKH9S0YB1PROD with NOTICES