### 37542 Federal Register / Vol. 78, No. 120 / Friday, June 21, 2013 / Notices

collaboration and informed decision making with the ultimate goal of reaching consensus on issues. Although formal responsibility for the agency’s overall government-to-government
consultation activities rests within the CDC Office of the Director (OD), other CDC Center, Institute, and Office (CIO) leadership shall actively participate in TAC meetings and HHS-sponsored regional and national tribal consultation sessions as frequently as possible.

Matters to Be Discussed: The TAC will convene their advisory committee meeting with discussions and presentations from various CDC senior
leaders on activities and areas identified by TAC members and other tribal leaders as priority public health issues. The following topics are scheduled for presentation and discussion during the TAC Meeting; however, discussion is not limited to these topics: Nativespecimens, direct assistance and EpiAids, success stories, and disease specific topics.

The 10th Biannual Tribal Consultation Session will engage CDC senior leadership from the CDC OD and
various CDC CIOs. Sessions that will be held during the Tribal Consultation include the following: A listening session with CDC’s director, roundtable discussions with CDC senior leadership, and an opportunity for tribal testimony.

Additional opportunities will be provided during the Consultation Session for tribal testimony. Tribal Leaders are encouraged to submit written testimony by 12:00 a.m., EST on July 19, 2013, to Kimberly Cantrell, Deputy Associate Director for Tribal Support, OSTLTS, via mail to 4770 Buford Highway NE., MS E–70, Atlanta, Georgia 30341 or email to tribalconsult@cdc.gov. Depending on the time available, it may be necessary to limit the time of each presenter.

The agenda is subject to change as priorities dictate.

Information about the TAC, CDC’s Tribal Consultation Policy, and previous meetings may be referenced on the following web link: http://www.cdc.gov/
tribal.

Contact Person For More Information: April R. Taylor, Public Health Analyst, CDC/OSTLTS, via mail to 4770 Buford Highway NE., MS E–70, Atlanta, Georgia 30341 or email to ARTaylor@cdc.gov.

The Director, Management Analysis and Services Office has been delegated the authority to sign Federal Register notices pertaining to announcements of meetings and other committee management activities, for both the
Centers for Disease Control and Prevention, and the Agency for Toxic Substances and Disease Registry.

Elaine L. Baker, Director, Management Analysis and Services Office, Centers for Disease Control and

Prevention.

[FR Doc. 2013–14779 Filed 6–20–13; 8:45 am]

**BILLING CODE 4163–18–P**

**DEPARTMENT OF HEALTH AND**
**HUMAN SERVICES**

**Centers for Disease Control and**
**Prevention**

**Disease, Disability, and Injury Prevention and Control Special**  **Emphasis Panel (SEP): Initial Review**

The meeting announced below concerns NIOSH Cooperative Agreement Research to Aid Recovery from Hurricane Sandy, Request for Applications (RFA) OH13–002, initial

review.

In accordance with Section 10(a)(2) of the Federal Advisory Committee Act (Pub. L. 92–463), the Centers for Disease Control and Prevention (CDC) announces the aforementioned meeting:

Time and Date: 1:00 p.m.–5:00 p.m., August 8, 2013 (Closed).

Place: Teleconference.
Status: The meeting will be closed to the public in accordance with provisions set forth in Section 552b(c)(4) and (6), Title 5 U.S.C., and the Determination of the Director, Management Analysis and Services Office, CDC, pursuant to Public Law 92–

463.

Matters to Be Discussed: The meeting will include the initial review, discussion, and evaluation of applications received in response to ‘‘NIOSH Cooperative Agreement Research to Aid Recovery from Hurricane Sandy RFA OH13–002.’’

Contact Person for More Information: Joan Karr, Ph.D., Scientific Review Officer, CDC/NIOSH 1600 Clifton Road, Mailstop E–74, Atlanta, Georgia 30333, Telephone: (404)498–2506.

The Director, Management Analysis and Services Office, has been delegated the authority to sign Federal Register notices pertaining to announcements of meetings and other committee management activities, for both the
Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry.

Elaine L. Baker, Director, Management Analysis and Services Office, Centers for Disease Control and

Prevention.

[FR Doc. 2013–14782 Filed 6–20–13; 8:45 am]

**BILLING CODE 4163–18–P DEPARTMENT OF HEALTH AND** 
**HUMAN SERVICES**

**Centers for Disease Control and**
**Prevention**

**Board of Scientific Counselors, National Center for Injury Prevention**  **and Control, (BSC, NCIPC)**

Correction: This notice was published
in the Federal Register on June 11, 2013, Volume 78, Number 112, Pages 35036–35037. The closing date for receipt of nominations was inadvertently omitted. Nominations must be submitted (postmarked or electronically received) by July 26,

2013.

Contact Person for More Information: Paul Middendorf, Senior Health Scientist, 1600 Clifton Rd. NE., MS: E– 20, Atlanta, GA 30329; telephone (404) 498–2548 (this is not a toll-free number); email: pmiddendorf@cdc.gov.

The Director, Management Analysis and Services Office, has been delegated the authority to sign Federal Register notices pertaining to announcements of meetings and other committee management activities, for both the
Centers for Disease Control and Prevention, and Agency for Toxic Substances and Disease Registry.

Elaine L. Baker, Director, Management Analysis and Services Office, Centers for Disease Control and

Prevention.

[FR Doc. 2013–14781 Filed 6–20–13; 8:45 am]

**BILLING CODE 4163–18–P**

**DEPARTMENT OF HEALTH AND**
**HUMAN SERVICES**

**Centers for Medicare & Medicaid**
**Services**

**[Document Identifiers: CMS–10116, CMS– R–245, CMS–1572, CMS–250–254, CMS–379,**  **CMS–4040, CMS–10174, CMS–10261, and CMS–R–285]** 

**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 (PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information (including each proposed


### 37543 Federal Register / Vol. 78, No. 120 / Friday, June 21, 2013 / Notices

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 20, 2013.

**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

lll, 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 :**  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–10116 Conditions for Payment of Power Mobility Devices, including Power Wheelchairs and Power-Operated
Vehicles.

CMS–R–245 Medicare and Medicaid Programs OASIS Collection Requirements as Part of the CoPs for HHAs and Supp. Regs. in 42 CFR 48.55,

484.205, 484.245, 484.250.

CMS–1572 Home Health Agency Survey and Deficiencies Report.

CMS–250–254 Medicare Secondary Payer Information Collection and Supporting Regulations.

CMS–379 Financial Statement of Debtor and Supporting Regulations.

CMS–4040 Request for Enrollment in Supplementary Medical Insurance.

CMS–10174 Collection of Prescription Drug Event Data from
Contracted Part D Providers for Payment.

CMS–10261 Part C Medicare Advantage Reporting Requirements and Supporting Regulations.

CMS–R–285 Request for Retirement
Benefit 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 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: Reinstatement without change of a previously approved collection; Title of Information Collection: Conditions for Payment of Power Mobility Devices, including Power Wheelchairs and Power-Operated Vehicles; Use: We are renewing our request for approval for the collection requirements associated with the final rule, CMS–3017–F (71 FR 17021), which published on April 5, 2006, and required a face-to-face examination of the beneficiary by the physician or treating practitioner, a written prescription, and receipt of pertinent parts of the medical record by the supplier within 45 days after the faceto-face examination that the durable medical equipment (DME) suppliers
maintain in their records and make available to CMS and its agents upon request. Form Number: CMS–10116 (OCN: 0938–0971); Frequency: Yearly; Affected Public: Private Sector— Business or other for-profits; Number of Respondents: 90,521; Number of Responses: 173,810; Total Annual

Hours: 34,762. (For policy questions regarding this collection contact Susan Miller at 410–786–2118.)

2. Type of Information Collection Request: Revision of a currently approved collection; Title of Information Collection: OASIS Collection Requirements as Part of the CoPs for HHAs and Supporting Regulations; Use: The OASIS data set is currently mandated for use by Home Health Agencies (HHAs) as a condition of participation (CoP) in the Medicare program. Since 1999, the Medicare CoPs
have mandated that HHAs use the OASIS data set when evaluating adult non-maternity patients receiving skilled
services. The OASIS is a core standard assessment data set that agencies integrate into their own patient-specific, comprehensive assessment to identify each patient’s need for home care that meets the patient’s medical, nursing, rehabilitative, social, and discharge planning needs. Form Number: CMS–R– 245 (OCN: 0938–0760); Frequency: Occasionally; Affected Public: Private Sector (Business or other for-profit and Not-for-profit institutions); Number of Respondents: 12,014; Total Annual Responses: 17,268,890; Total Annual

Hours: 15,305,484. (For policy questions regarding this collection contact Robin Dowell at 410–786–0060.)

3. Type of Information Collection Request: Reinstatement with change of a previously approved collection; Title of Information Collection: Home Health Agency Survey and Deficiencies Report;

Use: In order to participate in the Medicare Program as a Home Health Agency (HHA) provider, the HHA must
meet federal standards. This form is used to record information and patients’ health and provider compliance with requirements and to report the information to the federal government.
Form Number: CMS–1572 (OCN: 0938– 0355); Frequency: Yearly; Affected
Public: State, Local or Tribal Government; Number of Respondents:

3,830; Total Annual Responses: 3,830; Total Annual Hours: 958. (For policy questions regarding this collection

contact Patricia Sevast at 410–786– 8135.)

4. Type of Information Collection Request: Reinstatement without change


### 37544 Federal Register / Vol. 78, No. 120 / Friday, June 21, 2013 / Notices

of a previously approved collection; Title of Information Collection: Medicare Secondary Payer Information Collection and Supporting Regulations;

Use: We are seeking to renew approval
to collect information from beneficiaries, providers, physicians, insurers, and suppliers on health insurance coverage that is primary to Medicare. Collecting this information allows us to identify those Medicare
beneficiaries who are in situations where Medicare is statutorily required to be a secondary payer (MSP), thereby safeguarding the Medicare Trust Fund. Specifically, we use the information to accurately process and pay Medicare claims and to make necessary recoveries in accordance with § 1862(b) of the Act (42 U.S.C. 1395y(b)). If an active MSP
situation is identified and Medicare is inappropriately billed as primary, the claim will be rejected. The hospitals, other providers, physicians, pharmacies, and suppliers use the information collected (and furnished to them on the denial) to properly bill the appropriate primary payer. Completing an MSP questionnaire and making an accurate MSP determination helps hospitals, other providers, physicians, pharmacies, and suppliers to bill correctly the first time, saving the Medicare Program money and affording Medicare
beneficiaries an enhanced level of customer service (which, again, is particularly important in Part D due to the real-time adjudication of claims and the complicated nature of its benefit administration). Insurers, underwriters,third party administrators, and selfinsured/self-administered employers
use the information to ensure compliance with the law by refunding any identified mistaken payments to
Medicare. Form Number: CMS–250–254 (OCN: 0938–0214); Frequency: Occasionally; Affected Public: Individuals and Households, Private Sector, State, Local or Tribal Governments; Number of Respondents:

143,070,217; Total Annual Responses:

143,070,217; Total Annual Hours: 1,788,057. (For policy questions regarding this collection contact Ward Marsh at 410–786–6473.)

5. Type of Information Collection Request: Reinstatement without change of a previously approved collection; Title of Information Collection:
Financial Statement of Debtor and Supporting Regulations; Use: The form
CMS–379 is used to collect financial
information which is needed to evaluate requests from physicians and suppliers to pay indebtedness under an extended repayment schedule, or to compromise
a debt less than the full amount. Normally, when a Medicare Administrative Contractor (MAC) overpays a physician or supplier, the overpayment is associated with a single claim, and the amount of the overpayment is moderate. In these cases, the physician/supplier usually refunds the overpaid amount in a lump sum. Alternatively, the MAC may recoup the overpaid amount against future payments. A recoupment is the recovery by Medicare of any outstanding Medicare debt by reducing present or future Medicare payments and applying the amount withheld to the indebtedness. The recoupment can be made only if the physician or supplier accepts assignment since the MAC makes payment to the physician or supplier only on assigned claims.

Sometimes, however, an overpayment to a physician or supplier is exceptionally large, and it cannot be
recovered in the normal fashion. The large overpayment usually results from aberrant billing practices, such as billing for more expensive services than were
rendered. This could be discovered during routine review of a statistically valid sample of claims. The physician or supplier may be unable to refund a large overpaid amount in a single payment.
The MAC cannot recover the overpayment by recoupment if the physician/supplier does not accept assignment of future claims, or is not expected to file future claims because of going out of business, illness or death. In these unusual circumstances, the MAC has authority to approve or deny extended repayment schedules up to 12 months, or may recommend to that we approve up to 60 months. Before the MAC takes these actions, the MAC will require full documentation of the physician’s or supplier’s financial situation. Thus, the physician or supplier must complete form CMS–379.
Form Number: CMS–379 (OCN: 0938– 0270); Frequency: Occasionally; Affected Public: Private Sector— Business or other for-profits; Number of Respondents: 500; Total Annual Responses: 500; Total Annual Hours: 1,000. (For policy questions regarding this collection contact Ronke Fabayo at 410–786–4460.)

6. Type of Information Collection Request: Reinstatement without change of a previously approved collection; Title of Information Collection: Request for Enrollment in Supplementary Medical Insurance; Use: Form CMS– 4040 (and CMS–4040SP) is used to
establish entitlement to and enrollment
in Medicare Part B for beneficiaries who file for Part B only. The collected
information is used to determine
entitlement for individuals who meet the requirements in section 1836(2) of the Social Security Act as well as the entitlement of the applicant or their spouses to an annuity paid by OPM for premium deduction purposes. Form Number: CMS–4040 (OCN: 0938–0245); Frequency: Once; Affected Public: Individuals or households; Number of Respondents: 10,000; Total Annual Responses: 10,000; Total Annual Hours: 2,500. (For policy questions regarding this collection contact Lindsay Smith at 410–786–6843.)

7. Type of Information Collection Request: Reinstatement without change of a previously approved collection; Title of Information Collection: Collection of Prescription Drug Event
Data from Contracted Part D Providers for Payment; Use: The information users would include Pharmacy Benefit Managers, third party administrators and pharmacies and prescription drug plans, Medicare Advantage plans that offer integrated prescription drug and health care coverage, Fallbacks and other plans that offer coverage of outpatient prescription drugs under the
Medicare Part D benefit to Medicare beneficiaries. The data is used primarily for payment, but is also used for claim validation as well as for other legislated functions such as quality monitoring, program integrity, and oversight. Form Number: CMS–10174 (OCN: 0938– 0982); Frequency: Monthly; Affected
Public: Private sector (business or other for-profits and not-for-profit institutions); Number of Respondents:

747; Total Annual Responses:
947,881,770; Total Annual Hours: 1,896. (For policy questions regarding this collection contact Ivan Iveljic at 410– 786–3312.)

8. Type of Information Collection Request: Revision of a currently approved collection; Title of Information Collection: Part C Medicare Advantage Reporting Requirements and Supporting Regulations; Use: There are
a number of information users of Part C reporting, including CMS central and regional office staff that use this information to monitor health plans and
to hold them accountable for their performance, researchers, and other government agencies such as GAO. Health plans can use this information to
measure and benchmark their performance. We intend to make some of these data available for public reporting as ‘‘display measures’’ in

2013. Form Number: CMS–10261 (OCN: 0938–1054); Frequency: Yearly and semi-annually; Affected Public: Private sector (business or other for-profits); Number of Respondents: 588; Total Annual Responses: 6,715; Total Annual

Hours: 200,918. (For policy questions


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regarding this collection contact Terry Lied at 410–786–8973.)

9. Type of Information Collection Request: Reinstatement without change of a previously approved collection; Title of Information Collection: Request for Retirement Benefit Information; Use: Section 1818(d)(5) of the Social Security Act provides that former state and local government employees (who are age 65 or older, have been entitled to Premium Part A for at least 7 years, and did not have the premium paid for by a state, a political subdivision of a state, or an agency or instrumentality of one or more states or political subdivisions) may have the Part A premium reduced
to zero. These individuals must also have 10 years of employment with the state or local government employer or a combination of 10 years of employment with a state or local government employer and a non-government employer. Form CMS–R–285 is an essential part of the process of determining whether an individual qualifies for the premium reduction. The Social Security Administration will use this information to help determine whether a beneficiary meets the requirements for reduction of the Part A premium. Form Number: CMS–R–285 (OCN: 0938–0769). Frequency: Once. Affected Public: State, Local, or Tribal Governments; Number of Respondents:

500; Total Annual Responses: 500; Total
Annual Hours: 125. (For policy questions regarding this collection contact Lindsay Smith at 410–786– 6843.)

Dated: June 18, 2013. Martique Jones, Deputy Director, Regulations Development Group, Office of Strategic Operations and Regulatory Affairs.

[FR Doc. 2013–14878 Filed 6–20–13; 8:45 am]

**BILLING CODE 4120–01–P**

**DEPARTMENT OF HEALTH AND**
**HUMAN SERVICES**

**Centers for Medicare & Medicaid**
**Services**

**[Document Identifier: CMS–460]**

**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 22, 2013.

**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) 395–6974 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: Medicare Participating Physician or Supplier Agreement; Use: Section 1842(h) of the Social Security Act permits physicians and suppliers to voluntarily participate in Medicare Part B by agreeing to take assignment on all claims for services to
Medicare beneficiaries. The law also requires that the Secretary provide specific benefits to the physicians, suppliers and other persons who choose to participate. Form CMS–460 is the agreement by which the physician or supplier elects to participate in
Medicare. The collected information is used by Medicare contractors to provide the benefits the law provides for participating entities and to enable
contractors to enforce the Medicare limiting charge for physicians, suppliers and other persons who do not participate. It is also used by Medicare beneficiaries to assist them in locating physicians who will accept Medicare assignment on claims for services and therefore save them money. In addition, we use the form to gauge the
effectiveness of efforts to increase participation in Medicare. Form
Number: CMS–460 (OCN: 0938–0373); Frequency: Yearly; Affected Public:Private sector (business or other forprofits); Number of Respondents:

120,000; Total Annual Responses:

120,000; Total Annual Hours: 30,000. (For policy questions regarding this collection contact April Billingsley at 410–786–0140.)

Dated: June 18, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic Operations and Regulatory Affairs.

[FR Doc. 2013–14870 Filed 6–20–13; 8:45 am]

**BILLING CODE 4120–01–P**