Federal Register / Vol. 77, No. 49 / Tuesday, March 13, 2012 / Notices 14807 

of approximately 60 percent. In order to 

achieve this response rate, we would 

recommend a 3-staged approach to data 

collection: 

(1) Mailout of a covering letter, the 

paper survey questionnaire, and a 

postage-paid return envelope. 

(2) Mailout of a postcard that thanks 

respondents and reminds the nonrespondents to please return their 

survey. 

(3) Mailout of a follow-up covering 

letter, the paper survey questionnaire, 

and a postage-paid return envelope. 

Through the pilot test, we will 

determine the response rate that can be 

achieved using this approach. If it is 

deemed necessary, additional mailout 

reminders can be added to the protocol, 

or a telephone non-response step can be 

added to the protocol. 

Using the 3-step mail approach 

described above, we anticipate that data 

collection would occur over an 8 to 10 

weeks. This is to say, if the first survey 

mailing were dropped on May 1, we 

would anticipate completing data 

collection at the end of June or early 

July. Data would then be cleaned, scores 

would be generated, and data would be 

delivered to CMS. Through the pilot 

test, we will determine the precise 

timing required to achieve an acceptable 

response rate, but we are aiming to 

complete sampling, data collection, and 

scoring within a 12-week period. 

Subsequent to the publication of the 

60-day Federal Register notice (June 10, 

2011; 76 FR 34076), the survey 

instrument has been separated into two 

surveys. Prior to this action, there was 

one survey proposed for the Quality of 

Care and Appeals review types. Once 

approved by OMB, there will be two 

survey instruments that will request 

similar information: one for Quality of 

Care and one for Appeals. Form 

Number: CMS–10393 (OCN 0938–New); 

Frequency: Once; Affected Public: 

Individuals or households; Number of 

Respondents: 16,010; Number of 

Responses: 16,010; Total Annual Hours: 

4,002. (For policy questions regarding 

this collection, contact Coles Mercier at 

410–786–2112. For all other issues call 

(410) 786–1326.) 

3. Type of Information Collection 

Request: Extension without change of a 

currently approved collection; Title of 

Information Collection: 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; Use: This 

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. There have not been 

any changes to the PRA package that is 

associated with the 60-day Federal 

Register notice that published on 

December 16, 2011 (76 FR 78264); 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: 

11,495; Total Annual Responses: 

16,476,008; Total Annual Hours: 

16,567,968. (For policy questions 

regarding this collection contact Robin 

Dowell at 410–786–0060. For all other 

issues call 410–786–1326.) 

To obtain copies of the supporting 

statement and any related forms for the 

proposed paperwork collections 

referenced above, access CMS Web Site 

address at http://www.cms.hhs.gov/ 

PaperworkReductionActof1995, or 

Email your request, including your 

address, phone number, OMB number, 

and CMS document identifier, to 

Paperwork@cms.hhs.gov, or call the 

Reports Clearance Office on (410) 786– 

1326. 

To be assured consideration, 

comments and recommendations for the 

proposed information collections must 

be received by the OMB desk officer at 

the address below, no later than 5 p.m. 

on April 12, 2012. 

OMB, Office of Information and 

Regulatory Affairs, Attention: CMS 

Desk Officer, Fax Number: (202) 395– 

6974, Email: 

OIRA_submission@omb.eop.gov. 

Dated: March 6, 2012. 

Martique Jones, 

Director, Regulations Development Group, 

Division-B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2012–6036 Filed 3–12–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare and Medicaid 

Services 

[Document Identifier: CMS–10428] 

Emergency Clearance: Public 

Information Collection Requirements 

Submitted to the Office of Management 

and Budget (OMB) 

AGENCY: Centers for Medicare and 

Medicaid Services, HHS. 

In compliance with the requirement 

of section 3506(c)(2)(A) of the 

Paperwork Reduction Act of 1995, the 

Centers for Medicare and Medicaid 

Services (CMS), Department of Health 

and Human Services, is publishing the 

following summary of proposed 

collections for public comment. 

Interested persons are invited to send 

comments regarding this 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. 

We are, however, requesting an 

emergency review of the information 

collection referenced below. In 

compliance with the requirement of 

section 3506(c)(2)(A) of the Paperwork 

Reduction Act of 1995, we have 

submitted to the Office of Management 

and Budget (OMB) the following 

requirements for emergency review. We 

are requesting an emergency review to 

ensure compliance with section 

1862(a)(1)(A) of the Social Security Act. 

We cannot reasonably comply with the 

normal clearance procedures in that 

public harm is reasonably likely to 

result if normal clearance procedures 

are followed as stated in 5 CFR 

1320.13(a)(2)(i). 

1. Type of Information Collection 

Request: New collection; Title of 

Information Collection: Pre-Existing 

Condition Insurance Plan (PCIP) HIPAA 

Authorization Form; Use: Unless 

permitted or required by law, the Health 

Insurance Portability and 

Accountability Act (HIPAA) privacy 

regulation at 45 CFR 164.508 prohibits 

CMS’ Pre-Existing Condition Insurance 

Plan (PCIP) program (a HIPAA covered 

entity) from disclosing an individual’s 

protected health information without a 

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14808 Federal Register / Vol. 77, No. 49 / Tuesday, March 13, 2012 / Notices 

valid authorization. In order to be valid, 

an authorization must include specified 

core elements and statements. CMS will 

make available to PCIP applicants and 

enrollees a standard, valid authorization 

to enable beneficiaries to request the 

disclosure of their protected health 

information. CMS will make available to 

PCIP applicants and enrollees a 

standard, valid authorization to enable 

beneficiaries to communicate with PCIP 

about their personal health information. 

This is a critical tool because the 

population the PCIP program serves is 

comprised of individuals with preexisting conditions who may be 

incapacitated and need an advocate to 

help them apply for or receive benefits 

from the program. This standard 

authorization will simplify the process 

of requesting information disclosure for 

beneficiaries and minimize the response 

time for the PCIP program; Form 

Number: CMS–10428 (OMB 0938–New); 

Frequency: Occasionally; Affected 

Public: Private Sector (Business or other 

for-profit and Not-for-profit 

institutions); Number of Respondents: 

2,100; Total Annual Responses: 2,100; 

Total Annual Hours: 525. (For policy 

questions regarding this collection 

contact Laura Dash at 410–786–8623. 

For all other issues call 410–786–1326.) 

CMS is requesting OMB review and 

approval of this collection by March 22, 

2012. To be assured consideration, 

comments and recommendations for the 

proposed information collections must 

be received by via one of the methods 

below on March 19, 2012. 

To obtain copies of the supporting 

statement and any related forms for the 

proposed paperwork collections 

referenced above, access CMS’ Web Site 

address at http://www.cms.gov/ 

PaperworkReductionActof1995/PRAL/ 

list.asp or Email your request, including 

your address, phone number, OMB 

number, and CMS document identifier, 

to Paperwork@cms.hhs.gov, or call the 

Reports Clearance Office on (410) 786– 

1326. 

Interested persons are invited to send 

comments regarding the burden or any 

other aspect of these collections of 

information requirements. However, as 

noted above, comments on these 

information collection and 

recordkeeping requirements must be 

received via one of the following 

methods by March 19, 2012. 

1. Electronically. You may submit 

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) 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 CMS– 

10417, Room C4–26–05, 7500 Security 

Boulevard, Baltimore, Maryland 21244– 

1850. 

3. By Email to OMB. OMB, Office of 

Information and Regulatory Affairs, 

Attention: CMS Desk Officer, Email: 

OIRA_submission@omb.eop.gov. 

Dated: March 8, 2012. 

Martique Jones, 

Director, Regulations Development Group, 

Division B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2012–6035 Filed 3–12–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Submission for OMB Review; 

Comment Request 

Title: Descriptive Study of Tribal 

Temporary Assistance for Needy 

Families (TANF) Programs—Interview 

Guides. 

OMB No.: New Collection. 

Description: The Administration for 

Children and Families (ACF) is 

proposing an information collection 

activity as part of the Descriptive Study 

of Tribal TANF Programs. The proposed 

information collection consists of semistructured interviews and focus groups 

with key Tribal TANF respondents on 

questions of Tribal TANF 

administration, policies, service 

delivery, and program context. Through 

this information collection, ACF seeks 

to gain an in-depth, systematic 

understanding of program 

implementation, operations, outputs 

and outcomes in selected sites, and 

identify promising practices and other 

areas for further study. 

Respondents: Semi-structured 

interviews will be held with Tribal 

TANF administrators and staff, and staff 

of related programs. Focus groups will 

be held with Tribal TANF clients. 

Annual Burden Estimates 

Please note that the burden rates 

below are revised since the 60 day 

Federal Register Notice to reflect lower 

burden hours. 

TABLE 1—ANNUAL BURDEN ESTIMATES

Instrument 

Annual 

number of 

respondents 

Number of 

responses per 

respondent 

Average 

burden hours 

per response 

Total annual 

burden hours 

Discussion Guide for use with tribal TANF Administrators ............................. 4 1 1.5 6 

Discussion Guide for use with tribal TANF Staff ............................................. 12 1 1 12 

Discussion Guide for use with Focus Groups with tribal TANF clients .......... 20 1 2 40 

Discussion guide for use with staff of related programs ................................. 20 1 1 20 

All instruments: ......................................................................................... ........................ ........................ ........................ 78 

Additional Information 

Copies of the proposed collection may 

be obtained by writing to the 

Administration for Children and 

Families, Office of Planning, Research, 

and Evaluation, 370 L’Enfant 

Promenade, SW., Washington, DC 

20447, Attn: OPRE Reports Clearance 

Officer. All requests should be 

identified by the title of the information 

collection. Email address: 

OPREinfocollection@acf.hhs.gov. OMB 

Comment: OMB is required to make a 

decision concerning the collection of 

information between 30 and 60 days 

after publication of this document in the 

Federal Register. Therefore, a comment 

is best assured of having its full effect 

if OMB receives it within 30 days of 

publication. Written comments and 

recommendations for the proposed 

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