Federal Register / Vol. 79, No. 114 / Friday, June 13, 2014 / Notices 33927 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers CMS–10123 and 

10124, CMS–10147, CMS–10252, CMS– 

10305 and CMS–R–268] 

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 

August 12, 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 llll, 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–10123 and 10124 Fast Track 

Appeals Notices: NOMNC/DENC 

CMS–10147 Medicare Prescription 

Drug Coverage and Your Rights 

CMS–10252 Data Use Agreement 

(DUA) Certificate of Disposition 

(COD) for Data Acquired from the 

Centers for Medicare & Medicaid 

Services 

CMS–10305 Medicare Part C and Part 

D Data Validation 

CMS–R–268 Survey Tool for 

www.medicare.gov and 

www.cms.hhs.gov 

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 Collection 

1. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Fast Track 

Appeals Notices: NOMNC/DENC; Use: 

Providers shall deliver a Notice of 

Medicare (Provider) Non-Coverage 

(NOMNC) to beneficiaries/enrollees no 

later than two days prior to the end of 

Medicare-covered services in skilled 

nursing facilities, home health agencies, 

comprehensive outpatient rehabilitation 

facilities, and hospices. Beneficiaries, 

enrollees or both beneficiaries and 

enrollees will use this information to 

determine whether they want to appeal 

the service termination to their Quality 

Improvement Organization (QIO). If the 

beneficiaries, enrollees or both 

beneficiaries decide to appeal, the 

Medicare provider or health plan will 

send the QIO and appellant a Detailed 

Explanation of Non-Coverage (DENC) 

detailing the rationale for the 

termination decision. 

Form Number: CMS–10123 and 10124 

(OMB control number: 0938–0910); 

Frequency: Occasionally; Affected 

Public: Private sector—Business or other 

for-profits and Not-for-profit 

institutions; Number of Respondents: 

24,915; Total Annual Responses: 

5,347,980; Total Annual Hours: 927,901. 

(For policy questions regarding this 

collection contact Janet Miller at 404– 

562–1799.) 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Medicare 

Prescription Drug Coverage and Your 

Rights; Use: Through the delivery of this 

standardized notice, Part D plan 

sponsors’ network pharmacies are in the 

best position to inform enrollees (at the 

point of sale) about how to contact their 

Part D plan if their prescription cannot 

be filled and how to request an 

exception to the Part D plan’s formulary. 

The notice restates certain rights and 

protections related to the enrollees 

Medicare prescription drug benefits, 

including the right to receive a written 

explanation from the drug plan about 

why a prescription drug is not covered. 

Form Number: CMS–10147 (OMB 

control number: 0938–0975); Frequency: 

Occasionally; Affected Public: Private 

sector—Business or other for-profits; 

Number of Respondents: 56,000; Total 

Annual Responses: 37,620,000; Total 

Annual Hours: 626,749. (For policy 

questions regarding this collection 

contact Kathryn M. Smith at 410–786– 

7623.) 

3. Type of Information Collection 

Request: Extension of a currently 

mstockstill on DSK4VPTVN1PROD with NOTICES

33928 Federal Register / Vol. 79, No. 114 / Friday, June 13, 2014 / Notices 

approved collection; Title of 

Information Collection: Data Use 

Agreement (DUA) Certificate of 

Disposition (COD) for Data Acquired 

from the Centers for Medicare & 

Medicaid Services; Use: The Data Use 

Agreement (DUA) Certificate of 

Disposition (COD) is required to close 

out the release of the data under the 

DUA and to ensure the data are 

destroyed and not used for another 

purpose without written authorization 

from CMS. The Health Insurance 

Portability and Accountability Act 

(HIPAA) of 1996, § 1173(d) (Security 

Standards for Health Information) 

requires CMS to protect Personally 

Identifiable Information (PII). 

Additionally, the Federal Information 

Security Management Act (FISMA) of 

2002, § 3544(b) (Federal Agency 

Responsibilities—Agency Program) also 

requires CMS to develop policies and 

procedures for the protection and 

destruction of sensitive data to include 

PII. 

Form Number: CMS–10252 (OMB 

control number: 0938–1046); Frequency: 

Biennial; Affected Public: Private 

Sector—Business or other for-profits 

and Not-for-profit institutions; Number 

of Respondents: 500; Total Annual 

Responses: 1,000; Total Annual Hours: 

84. (For policy questions regarding this 

collection contact Sharon Kavanagh at 

410–786–5441.) 

4. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Medicare Part C 

and Part D Data Validation; Use: 

Organizations contracted to offer 

Medicare Part C and Part D benefits are 

required to report data to us on a variety 

of measures. For the data to be useful for 

monitoring and performance 

measurement, the data must be reliable, 

valid, complete, and comparable among 

sponsoring organizations. To meet this 

goal, we have developed reporting 

standards and data validation 

specifications with respect to the Part C 

and Part D reporting requirements. 

These standards provide a review 

process for Medicare Advantage 

Organizations, Cost Plans, and Part D 

sponsors to use to conduct data 

validation checks on their reported Part 

C and Part D data. The currently 

approved information collection is 

being revised to reflect decreases in the 

number of reporting sections being 

validated and an increase in the average 

number of data elements per reporting 

section for 2015–2017. 

Form Number: CMS–10305 (OMB 

control number: 0938–1115); Frequency: 

Yearly; Affected Public: Private sector— 

Business or other for-profits; Number of 

Respondents: 706; Total Annual 

Responses: 706; Total Annual Hours: 

202,578. (For policy questions regarding 

this collection contact Terry Lied at 

410–786–8973.) 

5. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Survey Tool for 

www.medicare.gov and 

www.cms.hhs.gov; Use: The Balanced 

Budget Act of 1997 states that the 

Secretary of Health and Human Services 

shall maintain a Web site to provide 

information about CMS activities, 

programs and topics related to its 

services. The present request is for OMB 

authorization to collect data on the 

reactions of users of the Web sites 

through the survey tool. We will use the 

data to improve the Web sites so that 

they can best serve the needs of their 

users. Information collected from the 

survey will be used to make 

improvements to the sites to make them 

more user friendly. 

Form Number: CMS–R–268 (OMB 

control number: 0938–0756); Frequency: 

Annual; Affected Public: Individuals or 

households; Number of Respondents: 

7,000; Total Annual Responses: 4,900; 

Total Annual Hours: 817. (For policy 

questions regarding this collection 

contact Kymeiria Ingram at 410–786– 

8431.) 

Dated: June 10, 2014. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2014–13863 Filed 6–12–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–10332] 

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 July 14, 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 

mstockstill on DSK4VPTVN1PROD with NOTICES