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 

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Federal Register / Vol. 79, No. 114 / Friday, June 13, 2014 / Notices 33929 

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: Disclosure for 

the In-Office Ancillary Services 

Exception; Use: Physicians who provide 

certain imaging services (magnetic 

resonance imaging, computed 

tomography, and positron emission 

tomography) under the in-office 

ancillary services exception to the 

physician self-referral prohibition are 

required to create the disclosure notice 

as well as the list of other imaging 

suppliers to be provided to the patient. 

The patient can use the disclosure 

notice and list of suppliers in making an 

informed-decision about his or her 

course of care for the imaging service. 

The physician must maintain a record of 

the disclosure in the patient’s medical 

record. If we were investigating the 

referrals of a physician providing 

advanced imaging services under the inoffice ancillary services exception, we 

would review the written disclosure to 

determine whether the physician 

satisfied the requirement. 

Form Number: CMS–10332 (OMB 

control number: 0938–1133); Frequency: 

Occasionally; Affected Public: Private 

sector—Business or other for-profits; 

Number of Respondents: 71,000; Total 

Annual Responses: 71,106; Total 

Annual Hours: 125,383. (For policy 

questions regarding this collection 

contact Jacqueline Proctor at 410–786– 

8852.) 

Dated: June 10, 2014. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2014–13858 Filed 6–12–14; 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: Evaluation of Tribal Health 

Profession Opportunity Grants (HPOG). 

OMB No.: 0970–0395. 

Description: The Administration for 

Children and Families (ACF), U.S. 

Department of Health and Human 

Services (HHS), is proposing to continue 

information collection activities as part 

of the Evaluation of the Tribal Health 

Profession Opportunity Grants (HPOG). 

These information collection activities 

were approved by OMB in October 2011 

for a three-year period (OMB clearance 

number 0970–0395). ACF is requesting 

a one-year extension of these activities. 

Through the extension of the 

information collection, ACF seeks to 

continue a comprehensive process and 

outcome evaluation to provide 

documentation and lessons learned 

about diverse programmatic approaches 

to health professions trainings for Tribal 

populations. 

The goals of the Tribal HPOG 

evaluation are to: (1) Provide an indepth, systematic analysis of program 

structure, implementation, and 

outcomes of the sites served by the five 

Tribal HPOG grantees funded in FY 

2010, and (2) compare these data within 

and across grantees to generate 

hypotheses about the effectiveness of 

different program approaches for Tribal 

populations. These goals require 

collecting information from Tribal 

HPOG grantees and other program 

stakeholders on an annual basis. The 

information collection activities include 

in-person and telephone interviews and 

focus groups. A one-year extension of 

these activities will allow the evaluation 

to gather data from the grantees through 

the end of their grant period. Program 

operations data related to this effort will 

continue to be collected through a webbased performance management system 

under a separate information collection 

(OMB clearance number 0970–0394). 

This Federal Register Notice provides 

the opportunity to comment on a 

proposed information collection activity 

for the evaluation of Tribal HPOG. All 

instruments included in this request 

have been previously approved. The 

burden represents continuing data 

collection into this period. 

Respondents: Grantee and Partner 

Administrative Staff interview: 

Administrators of the Tribal HPOG 

program, workforce development, and 

TANF agencies; public and private 

university-based partners; and not-for 

profit organizations. 

Program Implementation Staff 

interview: Instructors, trainers, and 

providers of program or supportive 

services. 

Program Participant focus groups: 

Current program participants. 

Employers interview: Local or regional 

employers at public or private 

companies or organizations that are 

partnering with the Tribal HPOG 

program or have employed program 

participants. 

Program Completers interview: 

Program completers. 

Program Non-completers interview: 

Individuals who did not complete the 

programs. 

Annual Burden Estimates 

The current information collection 

request is for a one-year period. 

Instrument 

Annual 

number of 

respondents 

Number of 

responses per 

respondent 

Average 

burden 

hours per 

response 

Annual 

burden 

hours 

New Burden for Previously Approved Instruments 

Grantee and partner administrative staff interview ........................................ 35 1 1 35 

Program implementation staff interview ........................................................ 120 1 1.5 180 

Program participant focus groups ................................................................. 108 1 1.5 162 

Employer interview ........................................................................................ 60 1 .75 45 

Program completers interview ....................................................................... 67 1 1 67 

Program non-completers interview ................................................................ 20 1 .30 6 

Estimated Total Annual Burden 

Hours: 495. 

In compliance with the requirements 

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

Paperwork Reduction Act of 1995, the 

Administration for Children and 

Families is soliciting public comment 

on the specific aspects of the 

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