Federal Register / Vol. 79, No. 172 / Friday, September 5, 2014 / Notices 53069 

revised subsequent to the publication of 

the 60-day Federal Register notice (June 

2, 2014; 79 FR 31336). Form Number: 

CMS–10340 (OMB control number: 

0938–1152); Frequency: Weekly; 

Affected Public: Private sector— 

Business or other for-profits; Number of 

Respondents: 683; Total Annual 

Responses: 516,493,635; Total Annual 

Hours: 34,433 (For policy questions 

regarding this collection contact 

Michael Massimini at 410–786–1566). 

5. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Data Use 

Agreement (DUA) Certificate of 

Disposition for Data Acquired from the 

Centers for Medicare & Medicaid 

Services (CMS); Use: The Privacy Act of 

1974 allows for discretionary releases of 

data maintained in Privacy Act 

protected systems of records under 

§ 552a(b) (Conditions of Disclosure). 

The mandate to account for disclosures 

of data under the Privacy Act is found 

at § 552a(c) (Accounting of Certain 

Disclosures). This section states that 

certain information must be maintained 

regarding disclosures made by each 

agency. This information is: Date, 

Nature, Purpose, and Name and Address 

of Recipient. Section 552a(e) sets the 

overall Agency Requirements that each 

agency must meet in order to maintain 

records under the Privacy Act. The Data 

Use Agreement (DUA) form is needed as 

part of the review of each CMS data 

request to ensure compliance with the 

requirements of the Privacy Act for 

disclosures that contain PII. The DUA 

form also provides data requestors and 

custodians with a formal means to agree 

to the data protection and destruction 

statutory and regulatory requirements of 

CMS’ PII data. The Health Insurance 

Portability and Accountability Act 

(HIPAA) of 1996, § 1173(d) (Security 

Standards for Health Information) 

requires CMS to protect Personally 

Identifiable Information (PII). 

Additionally, the Federal Information 

Security Management Act (FISMA) of 

2002, § 3544(b) (Federal Agency 

Responsibilities—Agency Program) also 

requires CMS to develop policies and 

procedures for the protection and 

destruction of sensitive data to include 

PII. The information collected by the 

DUA form is used by CMS to track 

disclosures, conditions for disclosure, 

accounting of disclosures and agency 

requirements dictated by the Privacy 

Act, HIPAA and FISMA. Form Number: 

CMS–R–235 (OMB control number: 

0938–0734); Frequency: Annually; 

Affected Public: Private Sector— 

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

Respondents: 9220; Total Annual 

Responses: 9220; Total Annual Hours: 

2740. (For policy questions regarding 

this collection contact Sharon Kavanagh 

at 410–786–5441.) 

6. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Survey Tool for 

www.medicare.gov and 

www.cms.hhs.gov; Use: The Balanced 

Budget Act of 1997 states that the 

Secretary of Health and Human Services 

shall maintain a Web site to provide 

information about CMS activities, 

programs and topics related to its 

services. The submission is for OMB 

authorization to collect data on the 

reactions of users of the Web sites 

through the survey tool. We will use the 

data to improve the Web sites so that 

they can best serve the needs of their 

users. Information collected from the 

survey will be used to make 

improvements to the sites to make them 

more user-friendly. Form Number: 

CMS–R–268 (OMB control number: 

0938–0756); Frequency: Annual; 

Affected Public: Individuals or 

households; Number of Respondents: 

7,000; Total Annual Responses: 4,900; 

Total Annual Hours: 817. (For policy 

questions regarding this collection 

contact Kymeiria Ingram at 410–786– 

8431.) 

7. Type of Information Collection 

Request: New collection (Request for a 

new OMB control number); Title of 

Information Collection: Physician 

Quality Reporting System (PQRS) and 

the Electronic Prescribing Incentive 

(eRx) Program Data Assessment, 

Accuracy and Improper Payments 

Identification Support; Use: The 

incentive and reporting programs have 

data integrity issues, such as rejected 

and improper payments. This four year 

project will evaluate incentive payment 

information for accuracy and identify 

improper payments, with the goal of 

recovering these payments. 

Additionally, based on the project’s 

results, recommendations will be made 

so that we can avoid future data 

integrity issues. 

Data submission, processing, and 

reporting will be analyzed for potential 

errors, inconsistencies, and gaps that are 

related to data handling, program 

requirements, and clinical quality 

measure specifications of PQRS and eRx 

program. Surveys of Group Practices, 

Registries, and Data Submission 

Vendors (DSVs) will be conducted in 

order to evaluate the PQRS and eRx 

Incentive Program. Follow-up 

interviews will occur with a small 

number of respondents. Form Number: 

CMS–10519 (OMB control number: 

0938–NEW); Frequency: Annually; 

Affected Public: Business or other forprofits; Number of Respondents: 115; 

Total Annual Responses: 115; Total 

Annual Hours: 201. (For policy 

questions regarding this collection 

contact Sungsoo Oh at 410–786–7611.) 

Dated: September 2, 2014. 

Martique Jones, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2014–21179 Filed 9–4–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers: CMS–10329, CMS– 

10422, CMS–10532 and CMS–10394] 

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 (the 

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 

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 

November 4, 2014. 

ADDRESSES: When commenting, please 

reference the document identifier or 

OMB control number (OCN). To be 

assured consideration, comments and 


rmajette on DSK2TPTVN1PROD with NOTICES
53070 Federal Register / Vol. 79, No. 172 / Friday, September 5, 2014 / Notices 

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 ___, 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: 

Contents 

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–10329 Consumer Operated and 

Oriented (CO–OP) Program 

CMS–10422 Payments for Services 

Furnished by Certain Primary Care 

Providers and Supporting Regulations in 

42 CFR 438.804, 447.400, and 447.410 

CMS–10532 Risk Corridors Transitional 

Policy 

CMS–10394 Application to Be a Qualified 

Entity to Receive Medicare Data for 

Performance Measurement 

Under the 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 Collection 

1. Type of Information Collection 

Request: Revision of a currently 

approved information collection; Title 

of Information Collection: Consumer 

Operated and Oriented (CO–OP) 

Program; Use: The Consumer Operated 

and Oriented Plan (CO–OP) program 

was established by Section 1322 of the 

Affordable Care Act. This program 

provides for loans to establish at least 

one consumer-operated, qualified 

nonprofit health insurance issuer in 

each State. Issuers supported by the 

CO–OP program will offer at least one 

qualified health plan at the silver level 

of benefits and one at the gold level of 

benefits in the individual market State 

Health Benefit Exchanges (Exchanges). 

At least two-thirds of policies or 

contracts offered by a CO–OP will be 

open to individuals and small 

employers. Profits generated by the 

nonprofit CO–OPs will be used to lower 

premiums, improve benefits, improve 

the quality of health care delivered to 

their members, expand enrollment, or 

otherwise contribute to the stability of 

coverage offered by the CO–OP. By 

increasing competition in the health 

insurance market and operating with a 

strong consumer focus, the CO–OP 

program will provide consumers more 

choices, greater plan accountability, 

increased competition to lower prices, 

and better models of care, benefiting all 

consumers, not just CO–OP members. 

The CO–OP program will provide 

nonprofits with loans to fund start-up 

costs and State reserve requirements, in 

the form of Start-up Loans and Solvency 

Loans. An applicant may apply for (1) 

joint Start-up and Solvency Loans; or (3) 

only a Solvency Loan. Planning Loans 

are intended to help loan recipients 

determine the feasibility of operating a 

CO–OP in a target market. Start-up 

Loans are intended to assist loan 

recipients with the many start-up costs 

associated with establishing a new 

health insurance issuer. Solvency Loans 

are intended to assist loan recipients 

with meeting the solvency requirements 

of States in which the applicant seeks to 

be licensed to issue qualified health 

plans. Form Number: CMS–10392 (OMB 

control number: 0938–1139); Frequency: 

Occasionally; Affected Public: Private 

sector—Not-for-profit institutions; 

Number of Respondents: 23; Total 

Annual Responses: 583; Total Annual 

Hours: 11,621. (For policy questions 

regarding this collection contact Deepti 

Loharikar (301–492–4126). 

2. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Payments for 

Services Furnished by Certain Primary 

Care Providers and Supporting 

Regulations in 42 CFR 438.804, 447.400, 

and 447.410; Use: The information will 

be used to document expenditures for 

the specified primary care services in 

the baseline period for the purpose of 

then calculating the expenditure eligible 

for 100 federal matching funds in 

calendar years 2015 and 2016, should 

Congress extend the availability of such 

funding and make no additional 

changes in statutory language 

necessitating programmatic alterations. 

Form Number: CMS–10422 (OMB 

control number: 0938–1170); Frequency: 

Yearly, once, and occasionally; Affected 

Public: State, Local, or Tribal 

Governments; Number of Respondents: 

51; Total Annual Responses: 126,021; 

Total Annual Hours: 63,240. (For policy 

questions regarding this collection 

contact Linda Tavener at 410–786– 

3838). 

3. Type of Information Collection 

Request: New collection (Request for a 

new OMB Control Number); Title of 

Information Collection: Risk Corridors 

Transitional Policy; Use: Section 1342 

of the Patient Protection and Affordable 

Care Act of 2010 (the Affordable Care 

Act) provides for the establishment of a 

temporary risk corridors program that 

will apply to qualified health plans in 

the individual and small group markets 

for the first three years of Exchange 

operation. The implementing 

regulations for this provision are located 

in Part 153 Title 45 of the Code of 

Federal Regulations. A final rule was 

published on March 11, 2014 (79 FR 

13834, CMS–9954–F) and is effective 

May 12, 2014. Under 45 CFR 153.530(e), 

each issuer conducting business in the 

individual and small group markets in 

states that adopted the transitional 

policy is required to submit enrollment 

data, including enrollment in 

transitional policies (i.e. individual or 

small group health insurance coverage 

in states that adopted the transitional 

policy announced in the Centers for 

Medicare and Medicaid (CMS) letter 

dated November 14, 2013), on the 

‘‘Transitional Adjustment Reporting 

Form’’ prescribed by CMS, for each state 

in which the issuer conducts business. 


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Federal Register / Vol. 79, No. 172 / Friday, September 5, 2014 / Notices 53071 

We will use the data collection to 

amend the risk corridors program 

provisions in 45 CFR Part 153 to 

mitigate any unexpected losses for 

issuers of plans subject to risk corridors 

that are attributable to the effects of this 

transitional policy. Specifically, we will 

use the data to calculate the risk 

corridors adjustment percentage, if any, 

in transitional states. Form Number: 

CMS–10532 (OMB control number: 

0938—New); Frequency: Once; Affected 

Public: Private Sector, Business or other 

for-profits and not-for-profit 

institutions; Number of Respondents: 

400; Total Annual Responses: 400; Total 

Annual Hours: 400. (For policy 

questions regarding this collection 

contact Jaya Ghildiyal at (301) 492– 

5149). 

4. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Application to 

Be a Qualified Entity to Receive 

Medicare Data for Performance 

Measurement; Use: Section 10332 of the 

Patient Protection and Affordable Care 

Act (ACA) requires the Secretary to 

make standardized extracts of Medicare 

claims data under Parts A, B, and D 

available to ‘‘qualified entities’’ for the 

evaluation of the performance of 

providers of services and suppliers. The 

statute provides the Secretary with 

discretion to establish criteria to 

determine whether an entity is qualified 

to use claims data to evaluate the 

performance of providers of services 

and suppliers. We are proposing at 

section 42 CFR 401.703 to evaluate an 

organization’s eligibility across three 

areas: Organizational and governance 

capabilities, addition of claims data 

from other sources (as required in the 

statute), and data privacy and security. 

This is the application through which 

organizations will provide information 

to CMS to determine whether they will 

be approved as a qualified entity. Form 

Number: CMS–10394 (OMB control 

number: 0938–1144); Frequency: 

Occasionally; Affected Public: Private 

sector—Business or other for-profits and 

Not-for-profit institutions; Number of 

Respondents: 35; Total Annual 

Responses: 35; Total Annual Hours: 

6,833. (For policy questions regarding 

this collection contact Kari Gaare at 

410–786–8612). 

Dated: September 2, 2014. 

Martique Jones, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2014–21180 Filed 9–4–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Comment Request 

Proposed Projects: 

Title: Office of Head Start (OHS) 

Information Collection Form. 

OMB No.: New Collection. 

Description: The Head Start Program 

Performance Standards (45 CFR parts 

1304.22(a)(3) and 1306.35(a)(4)(b)(1)) 

mandate that Head Start programs 

develop emergency preparedness plans 

and conduct periodic drills to ensure 

they have protocols in place, supported 

by policies and procedures, to ensure 

they can evacuate Head Start centers in 

an orderly fashion in the event of a 

disaster or public health emergency. 

OHS must ensure that contingency 

plans are in place prior, during and after 

a nationally declared disaster; and, that 

Head Start programs have arrangements 

(memorandums of understanding) with 

other community based organizations 

for shelter in place at alternative 

locations. The Presidential Policy 

Directive–8 (PPD–8), which President 

Obama signed in 2011, provides Federal 

guidance and planning procedures 

under established phases—Protection, 

Preparedness, Response, Recovery, and 

Mitigation. The data collected in the 

Information Collection Form addresses 

the areas of Response and Recovery. 

Respondents: Head Start and Early 

Head Start program grant recipients. 

ANNUAL BURDEN ESTIMATES

Instrument Number of 

respondents 

Number of 

responses per 

respondent 

Average 

burden hours 

per response 

(minutes) 

Total burden 

hours 

(minutes) 

OHS Information Collection Form .................................................................... * 1 1 30 30 

* The estimate above is based on a single disaster. The estimate is for a Head Start program with 1 center when all questions are applicable, 

depending on the type of disaster all questions may not be applicable; therefore the burden hours may be shorter. For Head Start programs with 

more than 1 center the burden hours may be longer. The number of respondents may increase based on the size of the disaster area. 

Estimated Total Annual Burden 

Hours: 30 Minutes. 

An estimate of the number of disasters 

that would warrant data collection is 

unavailable due to unpredictable nature 

of disasters. For example, in 2012, there 

were 95 disasters nationwide but ACF’s 

Office of Human Services Emergency 

Preparedness Response did not collect 

data on all of them because they had 

minimal effects on ACF programs. 

In compliance with the requirements 

of Section 506(c)(2)(A) of the Paperwork 

Reduction Act of 1995, the 

Administration for Children and 

Families is soliciting public comment 

on the specific aspects of the 

information collection described above. 

Copies of the proposed collection of 

information can be obtained and 

comments may be forwarded by writing 

to the Administration for Children and 

Families, Office of Planning, Research 

and Evaluation, 370 L’Enfant 

Promenade SW., Washington, DC 20447, 

Attn: ACF Reports Clearance Officer. 

Email address: infocollection@

acf.hhs.gov. All requests should be 

identified by the title of the information 

collection. 

The Department specifically requests 

comments 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) 

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. 

Consideration will be given to 


rmajette on DSK2TPTVN1PROD with NOTICES