### 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


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

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 Community**  **Based 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 

### B URDEN 

### H OURS

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