Federal Register / Vol. 79, No. 177 / Friday, September 12, 2014 / Notices 54725 

ESTIMATED ANNUALIZED BURDEN TO RESPONDENTS—Continued 

Respondents Form name Number of 

respondents 

Number of 

responses per 

respondent 

Average 

burden 

per response 

(in hours) 

School staff ...................................... Web-based instrument for San Francisco Unified 

School District.

163 1 25/60 

District-level Administrators .............. School Climate Index Interview Guide for District-level 

Administrators.

1 1 1 

School-level Administrators .............. School Climate Index Interview Guide for School-level 

Administrators.

9 1 1 

School Staff ...................................... School Climate Index Interview Guide for School Staff 19 1 1.5 

Leroy A. 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. 2014–21754 Filed 9–11–14; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10525] 

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 October 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 

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: Existing collection in use 

without an OMB control number; Title 

of Information Collection: Health Plan 

Monitoring System Level I and Level II 

Data Entry for the Program of AllInclusive Care for the Elderly; Use: This 

information collection would require 

Program of All-Inclusive Care for the 

Elderly (PACE) organizations to enter 

Level I and Level II data into the CMS’s 

Health Plan Monitoring System. The 

collected information will be used to 

develop a quality improvement strategy 

for PACE. Form Number: CMS–10525 

(OMB control number: 0938—New); 

Frequency: Quarterly and occasionally; 

Affected Public: Private sector— 

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

Respondents: 100; Total Annual 

Responses: 7,000; Total Annual Hours: 

1,575. (For policy questions regarding 

this collection contact Tamika Gladney 

at 410–786–0648). 

Dated: September 9, 2014. 

Martique Jones, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2014–21799 Filed 9–11–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10291, CMS– 

10421 and CMS–10114] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, HHS. 


tkelley on DSK3SPTVN1PROD with NOTICES
54726 Federal Register / Vol. 79, No. 177 / Friday, September 12, 2014 / Notices 

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 

November 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–10291 State Collection and 

Reporting of Dental Provider and 

Benefit Package Information on the 

Insure Kids Now! Web site and 

Hotline 

CMS–10421 Fee-for-Service Recovery 

Audit Prepayment Review 

Demonstration and Prior 

Authorization Demonstration 

CMS–10114 National Provider 

Identifier (NPI) Application and 

Update Form and Supporting Regs in 

45 CFR 142.408, 45 CFR 162.408, 45 

CFR 162.406 

Under the 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: Revision of a currently 

approved collection; Title of 

Information Collection: State Collection 

and Reporting of Dental Provider and 

Benefit Package Information on the 

Insure Kids Now! Web site and Hotline; 

Use: On the Insure Kids Now (IKN) Web 

site, the Secretary is required to post a 

current and accurate list of dentists and 

providers that provide dental services to 

children enrolled in the state plan (or 

waiver) under Medicaid or the state 

child health plan (or waiver) under 

CHIP. States collect the information 

pertaining to their Medicaid and CHIP 

dental benefits. Form Number: CMS– 

10291 (OMB control number: 0938– 

1065); Frequency: Yearly and quarterly; 

Affected Public: State, Local, or Tribal 

Governments; Number of Respondents: 

51; Total Annual Responses: 255; Total 

Annual Hours: 10,838. (For policy 

questions regarding this collection 

contact Laurie Norris at 410–786–6543). 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Fee-for-Service 

Recovery Audit Prepayment Review 

Demonstration and Prior Authorization 

Demonstration; Use: On July 23, 2012, 

the Office of Management and Budget 

approved the collections required for 

two demonstrations of prepayment 

review and prior authorization. The first 

demonstration allows Medicare 

Recovery Auditors to review claims on 

a pre-payment basis in certain States. 

The second demonstration established a 

prior authorization program for Power 

Mobility Device claims in certain States. 

For the Recovery Audit Prepayment 

Review Demonstration, CMS and its 

agents request additional 

documentation, including medical 

records, to support submitted claims. As 

discussed in more detail in Chapter 3 of 

the Program Integrity Manual, 

additional documentation includes any 

medical documentation, beyond what is 

included on the face of the claim that 

supports the item or service that is 

billed. For Medicare to consider 

coverage and payment for any item or 

service, the information submitted by 

the provider or supplier (e.g., claims) 

must be supported by the 

documentation in the patient’s medical 

records. When conducting complex 

medical review, the contractor specifies 

documentation they require in 

accordance with Medicare’s rules and 

policies. In addition, providers and 

suppliers may supply additional 

documentation not explicitly listed by 

the contractor. This supporting 

information may be requested by CMS 

and its agents on a routine basis in 

instances where diagnoses on a claim do 

not clearly indicate medical necessity, 

or if there is a suspicion of fraud. 

For the Prior Authorization of Power 

Mobility Devices (PMDs) 

Demonstration, we are piloting prior 

authorization for PMDs. Prior 

authorization will allow the applicable 

documentation that supports a claim to 

be submitted before the item is 

delivered. For prior authorization, 

relevant documentation for review is 

submitted before the item is delivered or 

the service is rendered. CMS will 

conduct this demonstration in 


tkelley on DSK3SPTVN1PROD with NOTICES
Federal Register / Vol. 79, No. 177 / Friday, September 12, 2014 / Notices 54727 

California, Florida, Illinois, Michigan, 

New York, North Carolina, Texas, 

Pennsylvania, Ohio, Louisiana, 

Missouri, Maryland, New Jersey, 

Indiana, Kentucky, Georgia, Tennessee, 

Washington, and Arizona based on 

beneficiary address as reported to the 

Social Security Administration and 

recorded in the Common Working File 

(CWF). For the demonstration, a prior 

authorization request can be completed 

by the (ordering) physician or treating 

practitioner and submitted to the 

appropriate DME MAC for an initial 

decision. The supplier may also submit 

the request on behalf of the physician or 

treating practitioner. The physician, 

treating practitioner or supplier who 

submits the request on behalf of the 

physician or treating practitioner, is 

referred to as the ‘‘submitter.’’ Under 

this demonstration, the submitter will 

submit to the DME MAC a request for 

prior authorization and all relevant 

documentation to support Medicare 

coverage of the PMD item. 

Form Number: CMS–10421 (OMB 

control number: 0938–1169); Frequency: 

Occasionally; Affected Public: State, 

Local or Tribal Governments; Number of 

Respondents: 333,750; Total Annual 

Responses: 333,750; Total Annual 

Hours: 170,060. (For policy questions 

regarding this collection contact Daniel 

Schwartz at 410–786–4197.) 

3. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: National 

Provider Identifier (NPI) Application 

and Update Form and Supporting 

Regulations in 45 CFR 142.408, 45 CFR 

162.406, 45 CFR 162.408; Use: The 

National Provider Identifier (NPI) 

Application and Update Form is used 

by health care providers to apply for 

NPIs and furnish updates to the 

information they supplied on their 

initial applications. The form is also 

used to deactivate their NPIs if 

necessary. The NPI Application/Update 

form has been revised to provide 

additional guidance on how to 

accurately complete the form. The NPI 

Application/Update form has been 

revised to provide additional guidance 

on how to accurately complete the form. 

This collection includes clarification on 

information that is required on 

applications/changes. Minor changes on 

the application/update form include 

adding a ‘Subpart’ check box in the 

Other Name section and a revision 

within the PRA Disclosure Statement. 

This collection also includes changes to 

the instructions. Form Number: CMS– 

10114 (OMB control number: 0938– 

0931); Frequency: Reporting—On 

occasion; Affected Public: Business or 

other for-profit, not-for-profit 

institutions, and Federal government; 

Number of Respondents: 608,880; Total 

Annual Responses: 608,880; Total 

Annual Hours: 112,660. (For policy 

questions regarding this collection 

contact Leslie Jones at 410–786–6599.) 

Dated: September 9, 2014. 

Martique Jones, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2014–21798 Filed 9–11–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Food and Drug Administration 

[Docket No. FDA–2010–N–0110] 

Agency Information Collection 

Activities; Announcement of Office of 

Management and Budget Approval; 

Prescription Drug Advertisements 

AGENCY: Food and Drug Administration, 

HHS. 

ACTION: Notice. 

SUMMARY: The Food and Drug 

Administration (FDA) is announcing 

that a collection of information entitled 

‘‘Prescription Drug Advertisements’’ has 

been approved by the Office of 

Management and Budget (OMB) under 

the Paperwork Reduction Act of 1995. 

FOR FURTHER INFORMATION CONTACT: FDA 

PRA Staff, Office of Operations, Food 

and Drug Administration, 8455 

Colesville Rd., COLE–14526, Silver 

Spring, MD 20993–0002, 

PRAStaff@fda.hhs.gov. 

SUPPLEMENTARY INFORMATION: On June 

12, 2014, the Agency submitted a 

proposed collection of information 

entitled ‘‘Prescription Drug 

Advertisements’’ to OMB for review and 

clearance under 44 U.S.C. 3507. An 

Agency may not conduct or sponsor, 

and a person is not required to respond 

to, a collection of information unless it 

displays a currently valid OMB control 

number. OMB has now approved the 

information collection and has assigned 

OMB control number 0910–0686. The 

approval expires on August 31, 2017. A 

copy of the supporting statement for this 

information collection is available on 

the Internet at http://www.reginfo.gov/ 

public/do/PRAMain. 

Dated: September 8, 2014. 

Leslie Kux, 

Assistant Commissioner for Policy. 

[FR Doc. 2014–21727 Filed 9–11–14; 8:45 am] 

BILLING CODE 4164–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Food and Drug Administration 

[Docket No. FDA–2014–N–1219] 

Agency Information Collection 

Activities; Proposed Collection; 

Comment Request; Survey of Health 

Care Practitioners for Device Labeling 

Format and Content 

AGENCY: Food and Drug Administration, 

HHS. 

ACTION: Notice. 

SUMMARY: The Food and Drug 

Administration (FDA) is announcing an 

opportunity for public comment on the 

proposed collection of certain 

information by the Agency. 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 and to allow 60 days for 

public comment in response to the 

notice. This notice solicits comments on 

the proposed information collection 

‘‘Survey of Health Care Practitioners for 

Device Labeling Format and Content.’’ 

DATES: Submit either electronic or 

written comments on the collection of 

information by November 12, 2014. 

ADDRESSES: Submit electronic 

comments on the collection of 

information to http://

www.regulations.gov. Submit written 

comments on the collection of 

information to the Division of Dockets 

Management (HFA–305), Food and Drug 

Administration, 5630 Fishers Lane, Rm. 

1061, Rockville, MD 20852. All 

comments should be identified with the 

docket number found in brackets in the 

heading of this document. 

FOR FURTHER INFORMATION CONTACT: FDA 

PRA Staff, Office of Operations, Food 

and Drug Administration, 8455 

Colesville Rd., COLE–14526, Silver 

Spring, MD 20993–0002, PRAStaff@

fda.hhs.gov. 

SUPPLEMENTARY INFORMATION: Under the 

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. 

‘‘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 provide a 60-day notice in 

the Federal Register concerning each 


tkelley on DSK3SPTVN1PROD with NOTICES