Federal Register / Vol. 78, No. 82 / Monday, April 29, 2013 / Notices 25085 

B. Federal Reserve Bank of Kansas 

City (Dennis Denney, Assistant Vice 

President) 1 Memorial Drive, Kansas 

City, Missouri 64198–0001: 

1. Gene R. Giles, Alliance, Nebraska, 

Sally J. Giles, Denver, Colorado, Randall 

D. Giles, San Diego, California, Nicholas 

G. Giles, and Lucas G. Giles, both of 

Lincoln, Nebraska; all of the Giles 

family group; the Bradley S. Norden 

Irrevocable Trust, and the Brett A. 

Norden Irrevocable Trust, Brett A. 

Norden and Bradley S. Norden, as cotrustees of both trusts, all of Highlands 

Ranch, Colorado, and as members of the 

Norden family group; the Michael L. 

Ryan 2011 Irrevocable Trust and the 

Cheryl L. Ryan 2012 Irrevocable Trust, 

both of Minden, Nebraska, Jeffrey M. 

Ryan, Heartwell, Nebraska, and Jamie 

Johnson, Minden, Nebraska, as cotrustees of both trusts; and Walter D. 

Wood Revocable Trust, Walter D. Wood, 

trustee, both of Omaha, Nebraska, as 

part of the Ryan/Wood family group; to 

acquire voting shares of First Central 

Nebraska Co., and thereby indirectly 

acquire voting shares of Nebraska State 

Bank and Trust Company, both in 

Broken Bow, Nebraska. 

Board of Governors of the Federal Reserve 

System, April 24, 2013. 

Michael J. Lewandowski, 

Assistant Secretary of the Board. 

[FR Doc. 2013–10030 Filed 4–26–13; 8:45 am] 

BILLING CODE 6210–01–P 

FEDERAL RESERVE SYSTEM 

Formations of, Acquisitions by, and 

Mergers of Bank Holding Companies 

The companies listed in this notice 

have applied to the Board for approval, 

pursuant to the Bank Holding Company 

Act of 1956 (12 U.S.C. 1841 et seq.) 

(BHC Act), Regulation Y (12 CFR part 

225), and all other applicable statutes 

and regulations to become a bank 

holding company and/or to acquire the 

assets or the ownership of, control of, or 

the power to vote shares of a bank or 

bank holding company and all of the 

banks and nonbanking companies 

owned by the bank holding company, 

including the companies listed below. 

The applications listed below, as well 

as other related filings required by the 

Board, are available for immediate 

inspection at the Federal Reserve Bank 

indicated. The applications will also be 

available for inspection at the offices of 

the Board of Governors. Interested 

persons may express their views in 

writing on the standards enumerated in 

the BHC Act (12 U.S.C. 1842(c)). If the 

proposal also involves the acquisition of 

a nonbanking company, the review also 

includes whether the acquisition of the 

nonbanking company complies with the 

standards in section 4 of the BHC Act 

(12 U.S.C. 1843). Unless otherwise 

noted, nonbanking activities will be 

conducted throughout the United States. 

Unless otherwise noted, comments 

regarding each of these applications 

must be received at the Reserve Bank 

indicated or the offices of the Board of 

Governors not later than May 24, 2013. 

A. Federal Reserve Bank of Atlanta 

(Chapelle Davis, Assistant Vice 

President) 1000 Peachtree Street NE., 

Atlanta, Georgia 30309: 

1. Oakworth Capital, Inc., 

Birmingham, Alabama; to become a 

bank holding company by acquiring 100 

percent of the voting shares of Oakworth 

Capital Bank, Birmingham, Alabama. 

B. Federal Reserve Bank of San 

Francisco (Gerald C. Tsai, Director, 

Applications and Enforcement) 101 

Market Street, San Francisco, California 

94105–1579: 

1. TFB Bancorp, Inc., Yuma, Arizona; 

to become a bank holding company by 

acquiring 100 percent of the voting 

shares of The Foothills Bank, Yuma, 

Arizona. 

Board of Governors of the Federal Reserve 

System, April 24, 2013. 

Michael J. Lewandowski, 

Assistant Secretary of the Board. 

[FR Doc. 2013–10029 Filed 4–26–13; 8:45 am] 

BILLING CODE 6210–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Agency for Healthcare Research and 

Quality 

Agency Information Collection 

Activities; Proposed Collection; 

Comment Request 

AGENCY: Agency for Healthcare Research 

and Quality, HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

intention of the Agency for Healthcare 

Research and Quality (AHRQ) to request 

that the Office of Management and 

Budget (OMB) approve the proposed 

information collection project: 

‘‘Improving Sickle Cell Transitions of 

Care through Health Information 

Technology Phase 1.’’ In accordance 

with the Paperwork Reduction Act, 44 

U.S.C. 3501–3521, AHRQ invites the 

public to comment on this proposed 

information collection. 

This proposed information collection 

was previously published in the Federal 

Register on February 7th, 2013 and 

allowed 60 days for public comment. No 

comments were received. The purpose 

of this notice is to allow an additional 

30 days for public comment. 

DATES: Comments on this notice must be 

received by May 29, 2013. 

ADDRESSES: Written comments should 

be submitted to: AHRQ’s OMB Desk 

Officer by fax at (202) 395–6974 

(attention: AHRQ’s desk officer) or by 

email at 

OIRA_submission@omb.eop.gov 

(attention: AHRQ’s desk officer). 

Copies of the proposed collection 

plans, data collection instruments, and 

specific details on the estimated burden 

can be obtained from the AHRQ Reports 

Clearance Officer. 

FOR FURTHER INFORMATION CONTACT: 

Doris Lefkowitz, AHRQ Reports 

Clearance Officer, (301) 427–1477, or by 

email at doris.lefkowitz@AHRQ.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Proposed Project 

Improving Sickle Cell Transitions of 

Care through Health Information 

Technology Phase I 

This project is the first phase in 

AHRQ’s effort toward the development 

of a health information technology (HIT) 

enabled tool designed to aid adolescents 

and young adults with sickle cell 

disease (SCD) during transitions of care. 

SCD is a serious, genetic blood disorder 

that affects approximately 70,000– 

100,000 Americans, including one out 

of every 500 African American and one 

out of every 36,000 Hispanic American 

births. Persons with SCD produce 

abnormal, ‘‘sickle-shaped’’ red blood 

cells that obstruct blood vessels, leading 

to life-long anemia, organ damage, 

increased potential for infections, 

chronic episodes of pain, and 

substantially shortened life spans. SCD 

has been noted to be understudied 

relative to its prevalence resulting in a 

lack of knowledge about the important 

variables and domains that determine 

health outcomes for patients. 

Furthermore, patients with SCD, 

typically young, minority, and often of 

lower income status, have had few 

opportunities to voice their needs and 

concerns about their health and health 

care. 

As recently as 30 years ago, children 

with SCD usually did not survive into 

adulthood. Now, as a result of advances 

in screening and treatment, more than 

90 percent of individuals with SCD 

reach adulthood, and life expectancy is 

typically into the fifth decade. Persons 

with SCD experience multiple 

transitions of care as a result of the 

chronicity of SCD, frequency of both 

acute and chronic-events requiring care, 


emcdonald on DSK67QTVN1PROD with NOTICES
25086 Federal Register / Vol. 78, No. 82 / Monday, April 29, 2013 / Notices 

as well as the advancements in life 

expectancy. Transitions of care occur 

when either the setting of care changes 

(e.g., from home-based to hospital-based 

care) or the focus of care changes (e.g., 

from pediatric-focused to adult-focused 

care). When transitions of care occur, a 

need to share medical history and other 

types of health information arises. 

Transitions of care are more likely to be 

successful when this health information 

is accurate, tailored to the type of 

transition taking place, and 

communicated effectively. 

Times of care transitions are 

particularly fraught for patients with 

SCD and currently, few patients have 

access to effective transition programs 

for SCD. In a 2010 survey of pediatric 

SCD providers, the majority claimed to 

have transition programs in place but 

they were often newly formed and 

without the ability to transfer care to 

adult providers with specific expertise 

in SCD. 

Preliminary evidence suggests that 

HIT can be helpful for SCD and similar 

conditions. In particular, a technologybased tool has already been used 

successfully by patients with SCD to 

help with some aspects of disease 

management. In one study, a handheld 

wireless device was used to implement 

a pain management protocol and found 

to result in high rates of participation 

and satisfaction. Technology-based tools 

or applications—‘‘apps’’—have also 

been effective in improving care 

transitions for other chronic diseases 

such as diabetes and HIV, which can 

serve as models for this tool. 

Improving transitions of care is the 

focus of AHRQ’s plans to respond to the 

Department of Health and Human 

Services’ (HHS’) SCD Initiative 

announced in 2011. The overall HHS 

SCD initiative, which is aligned with 

AHRQ’s mission, aims to improve the 

health of persons with SCD through 

various activities, including developing 

and disseminating evidence-based 

guidelines, increasing the availability of 

medical homes that provide SCD care, 

and supporting research in areas such as 

pain and disease management, all of 

which could also be supported through 

the use of an effective HIT enabled tool. 

The goals of this project are to: 

(1) Gain the necessary background 

knowledge including qualitative 

information from key stakeholders, to 

establish a set of requirements that 

would guide the design and 

development of a HIT-enabled tool in 

future phases of work that meets 

patients’, families’, and providers’ needs 

to aid adolescents and young adults 

with sickle cell disease during 

transitions of care. 

(2) Develop an understanding of the 

environmental context, current 

facilitators and barriers, health data use 

and needs of key stakeholders affected 

by sickle cell disease, including 

patients, families, and providers. 

This study is being conducted by 

AHRQ through its contractor, The 

Lewin Group in partnership with 

Children’s National Medical Center, 

Cincinnati Children’s Hospital Medical 

Center, Nemours Children’s ClinicJacksonville, and the National Initiative 

for Children’s Healthcare Quality, 

pursuant to AHRQ’s statutory authority 

to conduct and support research on 

healthcare and on systems for the 

delivery of such care, including 

activities with respect to the quality, 

effectiveness, efficiency, 

appropriateness and value of healthcare 

services and with respect to quality 

measurement and improvement. 42 

U.S.C. 299a(a)(1) and (2). 

Method of Collection 

To achieve the goals of this project, 

the following activities and data 

collections will be implemented: 

(1) Environmental Scan—AHRQ will 

execute a literature review to identify 

potentially relevant scientific literature 

and information from other literature 

and sources as well as complete a search 

for existing tools that aid transitions of 

care for persons with SCD or similar 

conditions. This will provide contextual 

background about the current state of 

the field with regards to tooldevelopment and use, identify keyissues of patients with SCD related to 

care transitions, and understand the 

context of care delivered and health 

data information needs to inform the 

content, design and functionality of a 

tool. This activity does not impose a 

burden on the public and is not 

included in the burden estimates in 

Exhibit 1. 

(2) Focus Groups—AHRQ will 

facilitate ten focus groups of key 

stakeholder groups including: parents/ 

caregivers of patients with SCD; health 

care providers (e.g. SCD specialists, 

primary care physicians (PCPs), 

hospitalists and emergency room (ER) 

physicians); IT developers; SCD patients 

ages 9–13; SCD patients ages 14–17; 

SCD patients 18 and older; and SCD 

patients of mixed ages; to gather 

qualitative information on stakeholder 

experiences with SCD and care 

transitions, barriers to quality care, and 

use of technology to inform tool design 

and functionality. Each group will 

consist of 10 participants and will be 

asked to describe their particular 

experiences with health care transitions, 

communication practices, information 

needs and technology use in order to 

develop relevant ‘‘use cases’’ which will 

be used by investigators and tool 

developers for the later phases of the 

project. The in-person nature of focus 

groups allows for a more in-depth and 

targeted discussion, including 

participant experiences, impressions 

and priorities in a detailed fashion. 

(3) Demographic Questionnaire— 

AHRQ will implement a short 

demographic questionnaire at the start 

of each of the ten focus groups to collect 

basic demographic information to allow 

the team to contextualize findings from 

each focus group. Questionnaires are 

tailored to each focus group category: 

Parents/caregivers of patients with SCD; 

providers, hospitalists and ER 

physicians; IT developers; SCD patients 

ages 9–13; SCD patients ages 14–17; 

SCD patients 18 and older; and SCD 

patients of mixed ages. 

(4) Key Informant Interviews—AHRQ 

will conduct eight key informant 

interviews with stakeholders such as 

State Medicaid representatives, 

attorneys with expertise in privacy and 

security issues, representatives from the 

Office of the National Coordinator for 

Health Information Technology (ONC), 

Office of Chief Scientist, and other 

relevant policy makers. Qualitative 

information gained will contribute to 

tool development recommendations 

particularly in terms of cost issues 

related to reimbursement by payers, 

needs for proof of effectiveness, 

sustainability, and potential vehicles for 

facilitating and funding tool 

development and implementation. 

The information gained from the 

focus groups and key informant 

interviews will be used to understand if 

and how a patient-centered, HITenabled tool can improve the health of 

individuals with SCD during care 

transitions. 

Focus groups as a form of qualitative 

research are an important vehicle for 

gathering and explicating insight from 

the field, especially if, as in this case, 

the important domains are not yet 

understood, and need to be outlined by 

respondents, rather than suggested by 

investigators. Thus active recruitment 

and qualitative techniques are a means 

to incorporate this necessary and 

important perspective into the 

derivation of effective interventions. 

The primary objective of the focus 

groups is to gather more richly nuanced 

information from sickle cell disease 

stakeholders. The in-person nature of 

focus groups allows for a more in-depth 

and targeted discussion, including 

participant experiences, impressions 

and priorities in a detailed fashion. 


emcdonald on DSK67QTVN1PROD with NOTICES
Federal Register / Vol. 78, No. 82 / Monday, April 29, 2013 / Notices 25087 

Estimated Annual Respondent Burden 

Exhibit 1 shows the estimated 

annualized burden hours for the 

respondents’ time to participate in this 

research. The demographic 

questionnaire will be completed by each 

focus group participant and takes 6 

minutes to complete. All of the focus 

groups and key informant interviews 

will last 2 hours except for the IT 

developer focus group which will last 4 

hours. Each focus group will consist of 

10 persons. There will be two focus 

groups with providers, three with 

parents/caregivers, one group for IT 

developers, and one focus group with 

each of the four patient groups. Key 

informant interviews will be conducted 

with eight individuals. The total burden 

is estimated to be 246 hours annually. 

Exhibit 2 shows the estimated 

annualized cost burden associated with 

the respondents’ time to participate in 

this research. The total cost burden is 

estimated to be $8,174 annually. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Form name Number of 

respondents 

Number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

Demographic Questionnaire ............................................................................ 100 1 6/60 10 

Provider Focus Groups .................................................................................... 20 1 2 40 

Parent/Caregiver Focus Groups ...................................................................... 30 1 2 60 

IT Developer Focus Group .............................................................................. 10 1 4 40 

Patients 9–13 Focus Group ............................................................................. 10 1 2 20 

Patients 14–17 Focus Group ........................................................................... 10 1 2 20 

Patients 18 & older Focus Group .................................................................... 10 1 2 20 

Patients mixed ages Focus Group .................................................................. 10 1 2 20 

Key Informant Interviews ................................................................................. 8 1 2 16 

Total .......................................................................................................... 208 na na 246 

EXHIBIT 2—ESTIMATED ANNUALIZE COST BURDEN

Form name Number of 

respondents 

Total burden 

hours 

Average 

hourly rate* 

Total cost 

burden 

Demographic Questionnaire ............................................................................ 100 10 a $26.89 $269 

Provider Focus Groups .................................................................................... 20 40 b 88.78 3,551 

Parent/Caregiver Focus Groups ...................................................................... 30 60 c 21.74 1,304 

IT Developer Focus Group .............................................................................. 10 40 d 44.27 1,771 

Patients 9–13 Focus Group ............................................................................. 10 20 e 0 0 

Patients 14–17 Focus Group ........................................................................... 10 20 e 0 0 

Patients 18 & older Focus Group .................................................................... 10 20 c 21.74 435 

Patients mixed ages Focus Group .................................................................. 10 20 e 0 0 

Key Informant Interviews ................................................................................. 8 16 f 52.72 844 

Total .......................................................................................................... 208 246 na 8,174

aBased on the mean wages for Physicians & Surgeons, All other (29–1069), All Occupations (00–0000), Software Developer (15–1132). 

Wages for children averaged in as $0. bBased on the mean wages for Physicians & Surgeons, All other (29–1069). 

cBased on the mean wages for All Occupations (00–0000). 

dBased on the mean wages for Software Developer (15–1132). 

e No wage data for children. 

fBased on the mean wages for Lawyers (23–1011), Social and Community Service Managers (11–9151), Medical and Health Services Managers (11–9111), and Computer and Information System Managers (11–3021). 

* National Compensation Survey: Occupational wages in the United States May 2011, ‘‘U.S. Department of_Labor, Bureau of Labor Statistics.’’http://www.bls.gov/oes/current/oes_nat.htm#15–0000. 

Estimated Annual Costs to the Federal 

Government 

Exhibit 3 shows the estimated total 

and annualized cost to the federal 

government over 18 months. The total 

cost to the federal government of this 

data collection effort is $264,043. This 

figure includes development of draft 

and final plans for conducting focus 

groups and interviews; development of 

materials including moderator guides 

for each stakeholders group (seven 

guides in total), recruitment materials 

for all four sites, consent forms; 

facilitating IRB approval processes at 

four sites; logistics coordination 

including securing facility space; 

recruitment of participants; incentives 

for participants (as described in section 

9 above); and analyzing and 

summarizing findings as well as 

preparing final reports. 

EXHIBIT 3—ESTIMATED TOTAL AND ANNUALIZED COST

Cost component Total cost Annualized cost 

Project Development ................................................................................................................................... $23,689 $15,793 

Data Collection Activities ............................................................................................................................. 169,586 113,057 

Data Processing and Analysis ..................................................................................................................... 16,000 10,667 

Publication of Results .................................................................................................................................. 33,472 22,315 


emcdonald on DSK67QTVN1PROD with NOTICES
25088 Federal Register / Vol. 78, No. 82 / Monday, April 29, 2013 / Notices 

EXHIBIT 3—ESTIMATED TOTAL AND ANNUALIZED COST—Continued 

Cost component Total cost Annualized cost 

Project Management .................................................................................................................................... 18,319 12,213 

Overhead ..................................................................................................................................................... 2,977 1,985 

Total ...................................................................................................................................................... 264,043 176,029 

Request for Comments 

In accordance with the Paperwork 

Reduction Act, comments on AHRQ’s 

information collection are requested 

with regard to any of the following: (a) 

Whether the proposed collection of 

information is necessary for the proper 

performance of AHRQ health care 

research and health care information 

dissemination functions, including 

whether the information will have 

practical utility; (b) the accuracy of 

AHRQ’s estimate of burden (including 

hours and costs) of the proposed 

collection(s) of information; (c) ways to 

enhance the quality, utility, and clarity 

of the information to be collected; and 

(d) ways to minimize the burden of the 

collection of information upon the 

respondents, including the use of 

automated collection techniques or 

other forms of information technology. 

Comments submitted in response to this 

notice will be summarized and included 

in the Agency’s subsequent request for 

OMB approval of the proposed 

information collection. All comments 

will become a matter of public record. 

Dated: April 15, 2013. 

Carolyn M Clancy, 

Director. 

[FR Doc. 2013–09742 Filed 4–26–13; 8:45 am] 

BILLING CODE 4160–90–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

[60Day–13–13RE] 

Proposed Data Collections Submitted 

for Public Comment and 

Recommendations 

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 

Centers for Disease Control and 

Prevention (CDC) will publish periodic 

summaries of proposed projects. To 

request more information on the 

proposed projects or to obtain a copy of 

the data collection plans and 

instruments, call 404–639–7570 or send 

comments to Ron Otten, at 1600 Clifton 

Road, MS D74, Atlanta, GA 30333 or 

send an email to omb@cdc.gov. 

Comments are invited on: (a) Whether 

the proposed collection of information 

is necessary for the proper performance 

of the functions of the agency, including 

whether the information shall have 

practical utility; (b) the accuracy of the 

agency’s estimate of the burden of the 

proposed collection of information; (c) 

ways to enhance the quality, utility, and 

clarity of the information to be 

collected; and (d) ways to minimize the 

burden of the collection of information 

on respondents, including through the 

use of automated collection techniques 

or other forms of information 

technology. Written comments should 

be received within 60 days of this 

notice. 

Proposed Project 

Public Health Systems, Mental Health 

and Community Recovery—New— 

Office of Public Health Preparedness 

and Response, Division of State and 

Local Readiness, Centers for Disease 

Control and Prevention (CDC). 

Background and Brief Description 

This project stems from, and aligns 

with, publication of the Office of Public 

Health Preparedness and Response’s 

(OPHPR) ‘‘National Strategic Plan for 

Public Health Preparedness and 

Response’’ which provides overall 

direction for Centers for Disease Control 

and Prevention’s (CDC) preparedness 

and response portfolio, including 

programmatic direction across OPHPR’s 

four divisions. The focus of this project 

is to generate findings useful for future 

preparedness planning and response in 

order to develop strategies and 

interventions aimed at mitigating the 

impact of adverse events. In April 2011, 

one of the largest tornado outbreaks ever 

recorded, a ‘‘Super Outbreak,’’ occurred 

in the southeastern United States, 

resulting in more than 300 deaths and 

an estimated $11 million in damages. 

This large-scale multistate tragedy offers 

a unique opportunity to study how 

communities with similar cultural and 

geographic features yet different public 

health and mental health emergency 

response systems could provide access 

to care around the same crisis. The 

outcomes of these efforts can inform the 

field of what effect these differences had 

on the recovery patterns of each of these 

communities. By doing so, we can begin 

to elucidate best practices for robust 

community preparedness and recovery 

with attention to types of services that 

most effectively promote the natural 

resilience of survivors. Two primary 

research questions will guide the 

proposed study: 

1. How did the Alabama and 

Mississippi State and local public 

health and mental health (PH/MH) 

systems prepare for, respond to, and 

support recovery after the April 2011 

tornados? 

2. To what extent have these 

communities recovered and what is the 

overall health and quality of life of 

individuals affected by these events? 

CDC requests Office of Management 

and Budget (OMB) approval to collect 

information for two years. 

To address these questions, CDC, in 

collaboration with ICF International, 

will conduct a mixed method evaluation 

utilizing key informant interviews of 

public health and mental health agency 

staff and other community 

representatives at the local, county and 

State levels and household survey data 

in each of the four regions in 

Mississippi and Alabama to assess 

community recovery and resilience. 

Specifically, the study design includes 

two main components (qualitative and 

quantitative) designed to 

comprehensively examine the PH/MH 

system response to and community 

recovery and resilience from disasters. 

The total estimated burden for the 98 

one-time qualitative interviews for 

public health/mental health 

professionals and community leaders is 

98 hours (98 respondents × 1 hour/ 

response). Interviews will be conducted 

during an in-person site-visit to the 

region to reduce travel and time burdens 

on the respondents. Respondents unable 

to participate during the site visit may 

participate via telephone. In addition, 

the total estimated burden for the 

quantitative computer-assisted 

interviews are based on 860 respondents 

in each of the four tornado effected 

regions; each survey will be 

approximately 25 minutes (4 counties × 

860 respondents = 3,440 respondents; 


emcdonald on DSK67QTVN1PROD with NOTICES