140 Federal Register / Vol. 79, No. 1 / Thursday, January 2, 2014 / Notices 

Dated: December 27, 2013. 

Karlos Morgan, 

Acting Director, Federal Acquisition Policy 

Division, Office of Government-wide 

Acquisition Policy, Office of Acquisition 

Policy, Office of Government-wide Policy. 

[FR Doc. 2013–31413 Filed 12–31–13; 8:45 am] 

BILLING CODE 6820–34–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers: CMS–40B, CMS– 

2088–92, and CMS–R–297 (CMS–L564)] 

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 February 3, 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: New collection (Request for a 

new OMB control number); Title of 

Information Collection: Application for 

Enrollment in Medicare the Medical 

Insurance Program; Use: Form CMS– 

40B is used to establish entitlement to 

and enrollment in supplementary 

medical insurance for beneficiaries who 

already have Part A, but not Part B. The 

form solicits information that is used to 

determine enrollment for individuals 

who meet the requirements in section 

1836 of the Social Security Act as well 

as the entitlement of the applicant or a 

spouse regarding a benefit or annuity 

paid by the Social Security 

Administration or the Office of 

Personnel Management for premium 

deduction purposes. The Social Security 

Administration will use the collected 

information to establish Part B 

enrollment. Form Number: CMS–40B 

(OCN: 0938-New); Frequency: Once; 

Affected Public: Individuals or 

households; Number of Respondents: 

200,000; Total Annual Responses: 

200,000; Total Annual Hours: 50,000. 

(For policy questions regarding this 

collection contact Lindsay Smith at 

410–786–6843.) 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Outpatient 

Rehabilitation Facility, Community 

Mental Health Center Cost Report and 

Supporting Regulations; Use: The cost 

reports are required to be filed with the 

provider’s Medicare Administrative 

Contractor (MAC). The MAC uses the 

cost reports to calculate the provider’s 

cost to charge ratios which are used to 

compute outlier payments and to 

determine a provider’s final cost 

settlement by comparing the provider’s 

interim payments received to the 

reasonable cost for the fiscal period 

covered by the cost report. 

The collection of data is a secondary 

function of the cost report. We use the 

data to support program operations, 

payment refinement activities, and to 

make Medicare Trust Fund projections. 

We along with other stakeholders use 

the data to analyze a myriad of health 

care measures on a national level. 

Stakeholders include the Office of 

Management and Budget, the 

Congressional Budget Office, the 

Medicare Payment Advisory 

Commission, Congress, researchers, 

universities, and other interested 

parties. Form Number: CMS–2088–92 

(OCN: 0938–0037); Frequency: Yearly; 

Affected Public: Private sector— 

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

Respondents: 540; Total Annual 

Responses: 540; Total Annual Hours: 

54,000. (For policy questions regarding 

this collection contact Jill Keplinger at 

410–786–4550.) 

3. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Request for 

Employment Information; Use: Section 

1837(i) of the Social Security Act 

provides for a special enrollment period 

for individuals who delay enrolling in 

Medicare Part B because they are 

covered by a group health plan based on 

their own or a spouse’s current 

employment status. Disabled 

individuals with Medicare may also 

delay enrollment because they have 

large group health plan coverage based 

on their own or a family member’s 

current employment status. When these 

individuals apply for Medicare Part B, 

they must provide proof that the group 

health plan coverage is (or was) based 

on current employment status. Form 

maindgalligan on DSK5TPTVN1PROD with NOTICES

Federal Register / Vol. 79, No. 1 / Thursday, January 2, 2014 / Notices 141 

Number: CMS–R–297 (CMS–L564) 

(OCN: 0938–0787); Frequency: Once; 

Affected Public: Private sector— 

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

Respondents: 15,000; Total Annual 

Responses: 15,000; Total Annual Hours: 

5,000. (For policy questions regarding 

this collection contact Lindsay Smith at 

410–786–6843.) 

Dated: December 27, 2013. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2013–31390 Filed 12–31–13; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

National Institutes of Health 

Proposed Collection; 60-Day Comment 

Request: Cardiovascular Health and 

Needs Assessment in Washington, 

DC—Development of a CommunityBased Behavioral Weight Loss 

Intervention 

Summary: In compliance with the 

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

the Paperwork Reduction Act of 1995, 

for opportunity for public comment on 

proposed data collection projects, the 

National Heart, Lung and Blood 

Institute (NHLBI), National Institutes of 

Health (NIH), will publish periodic 

summaries of proposed projects to be 

submitted to the Office of Management 

and Budget (OMB) for review and 

approval. 

Written comments and/or suggestions 

from the public and affected agencies 

are invited on one or more of the 

following points: (1) Whether the 

proposed collection of information is 

necessary for the proper performance of 

the function of the agency, including 

whether the information will have 

practical utility; (2) The accuracy of the 

agency’s estimate of the burden of the 

proposed collection of information, 

including the validity of the 

methodology and assumptions used; (3) 

Ways to enhance the quality, utility, and 

clarity of the information to be 

collected; and (4) Ways to minimize the 

burden of the collection of information 

on those who are to respond, including 

the use of appropriate automated, 

electronic, mechanical, or other 

technological collection techniques or 

other forms of information technology. 

To Submit Comments and for Further 

Information: To obtain a copy of the 

data collection plans and instruments, 

submit comments in writing, or request 

more information on the proposed 

project, contact either: Eric Shropshire, 

Outreach & Research Coordinator, or Dr. 

Tiffany Powell-Wiley, Assistant Clinical 

Investigator, CPB, DIR, NHLBI, NIH, 10 

Center Drive, Building 10–CRC, 5– 

3340,, Bethesda, MD 20892, or call nontoll-free number Eric Shropshire, (301) 

827–4981–5579 or Dr. Powell-Wiley, 

(301) 594–3735, or Email your request, 

including your address to either 

Eric.Shropshire@nih.gov or 

Tiffany.Powell-Wiley@nih.gov. Formal 

requests for additional plans and 

instruments must be requested in 

writing. 

Comment Due Date: Comments 

regarding this information collection are 

best assured of having their full effect if 

received within 60 days of the date of 

this publication. 

Proposed Collection: Cardiovascular 

Health and Needs Assessment in 

Washington, DC—Development of a 

Community-Based Behavioral Weight 

Loss Intervention, -New, National Heart, 

Lung and Blood Institute (NHLBI), 

National Institutes of Health (NIH). 

Need and Use of Information 

Collection: The purpose and use of the 

information collection for this project is 

to determine the prevalence of ideal, 

intermediate, and poor cardiovascular 

health factors based on American Heart 

Association (AHA)-defined goals within 

a church-based population in wards 5, 

7, and 8 in Washington, DC. The 

information collected will also evaluate 

data from handheld devices, such as 

wearable physical activity monitors or 

digital cameras, to objectively measure 

physical activity and dietary intake from 

selected community members. This 

protocol will then identify technology 

that may be incorporated into future 

interventions. In addition, the collected 

information used will be examined for 

methods of referral for treatment for 

unrecognized hypertension, diabetes, 

and hypercholesterolemia in the 

community-based population. Social 

determinants of obesity, particularly 

environmental, cultural, and 

psychosocial factors that might help or 

hinder weight loss, will be evaluated in 

the population. This information from 

the screening and needs assessment will 

establish a CBPR partnership for the 

future design and implementation of a 

church-based, behavioral weight loss 

intervention. 

OMB approval is requested for 2 

years. There are no costs to respondents 

other than their time. The total 

estimated annualized burden hours are 

2,380. 

ESTIMATED ANNUALIZED BURDEN HOURS

A.12—1 Estimates of Hour Burden 

Type of respondents Number of 

respondents 

Frequency of 

response 

Average time 

per response 

Annual hour 

burden 

Consent Process ............................................................................................. 100 1 15/60 25 

Clinical Evaluation ........................................................................................... 100 1 30/60 50 

Survey Instrument ............................................................................................ 100 1 1 100 

Device Training ................................................................................................ 100 2 1 200 

Health Data Monitoring .................................................................................... 100 2 10 2,000 

Device Return .................................................................................................. 15 1 18/60 5 

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