73648 Federal Register / Vol. 76, No. 229 / Tuesday, November 29, 2011 / Notices 

• January 13, 2012 12 p.m.–1 p.m. 

EST. Webinar registration site: https:// 

www3.gotomeeting.com/register/ 

807742630; 

• January 20, 2012, 12 p.m.–1 p.m. 

EST. Webinar registration site: https:// 

www3.gotomeeting.com/register/ 

133770238; and 

• January 20, 2012, 3 p.m.–4 p.m. 

EST. Webinar registration site: https:// 

www3.gotomeeting.com/register/ 

367222398. 

Purpose of Each Webinar 

The December 20, 2011 Webinar will 

provide a general overview of the 

National Healthy Worksite Program 

including program goals and objectives, 

program components and employer 

activities, timelines, and anticipated 

program outcomes. 

The January 2012 Webinars will (1) 

Provide a general overview of the 

National Healthy Worksite Program; (2) 

review the process and criteria HHS/ 

CDC used to identify the seven locations 

where the program will take place; (3) 

announce those locations; and (4) 

discuss the employer certification 

process and criteria HHS/CDC will use 

to identify and select up to 100 

employers participating in the National 

Healthy Worksite Program. 

HHS/CDC plans to publish notices in 

the Federal Register announcing (1) The 

seven locations where the program will 

take place and the criteria used for 

selection; and (2) the employer 

certification process and criteria HHS/ 

CDC will use to identify and select up 

to 100 participating employers across 

the seven selected locations. 

Special Accommodations 

HHS/CDC will make every effort to 

accommodate persons with disabilities 

or special needs. HHS/CDC will make 

slides and an audio and written 

transcript of the Webinars available on 

its Web site, http://www.cdc.gov/ 

NationalHealthyWorksite. If you require 

additional special accommodations due 

to a disability, please contact Jason 

Lang, National Center for Chronic 

Disease Prevention and Health 

Promotion, at (770) 488–5269 at least 7 

days in advance of the meeting. 

Dated: November 21, 2011. 

James W. Stephens, 

Director, Office of Science Quality, Office of 

the Associate Director for Science, Center for 

Disease Control and Prevention. 

[FR Doc. 2011–30649 Filed 11–28–11; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–29 and CMS–209] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

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 & Medicaid 

Services (CMS) 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. 

1. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Request for 

Certification as a Rural Health Clinic 

Form and Supporting Regulations in 42 

CFR 491.1–491.11; Use: The Form 

CMS–29, Request for Certification as a 

Supplier of Rural Health Clinic (RHC) 

Services under the Medicare/Medicaid 

Program, is utilized as an application to 

be completed by suppliers of RHC 

services requesting participation in the 

Medicare program. This form initiates 

the process of obtaining a decision as to 

whether the conditions for certification 

are met as a supplier of RHC services. 

It also promotes data reduction or 

introduction to and retrieval from the 

Automated Survey Process Environment 

(ASPEN) and related survey and 

certification databases by the CMS 

Regional Offices. Should any question 

arise regarding the structure of the 

organization, this information is readily 

available. With this renewal request, the 

title of the Form CMS–29 is being 

revised to better describe the purpose of 

the data being collected. Both new and 

existing clinics must provide and attest 

to the accuracy of specific clinic data as 

a part of the RHC certification process. 

Therefore, the revised title is ‘‘Form 

CMS–29/Verification of Clinic Data— 

Rural Health Clinic Program.’’ The Form 

CMS–29 is also being revised to remove 

Section V, Federal Support. The 

information captured under Section V is 

not a deciding factor as to whether or 

not a clinic meets RHC certification 

requirements. Therefore, it is 

unnecessary to require facilities to 

complete this section as a part of the 

certification process; Form Number: 

CMS–29 (OCN 0938–0074); Frequency: 

Occasionally (initially and then every 

six years); Affected Public: Private 

Sector (Business or other for-profit and 

Not-for-profit institutions); Number of 

Respondents: 3,981; Total Annual 

Responses: 830; Total Annual Hours: 

138. (For policy questions regarding this 

collection contact Shonte ́ Carter at (410) 

786–3532. For all other issues call (410) 

786–1326.) 

2. Type of Information Collection 

Request: Extension without change of a 

currently approved collection; Title of 

Information Collection: Laboratory 

Personnel Report (CLIA) and Supporting 

Regulations in 42 CFR 493.1357, 

493.1363, 493.1405, 493.1406, 493.1411, 

493.1417, 493.1423, 493.1443, 493.1449, 

493.1455, 493.1461, 493.1462, 493.1469, 

493.1483, 493.1489 and 493.1491; Use: 

The information collected on this 

survey form is used in the 

administrative pursuit of the 

Congressionally mandated program with 

regard to regulation of laboratories 

participating in CLIA. The surveyor will 

provide the laboratory with the CMS– 

209 form. While the surveyor performs 

other aspects of the survey, the 

laboratory will complete the CMS–209 

by recording the personnel data needed 

to support their compliance with the 

personnel requirements of CLIA. The 

surveyor will then use this information 

in choosing a sample of personnel to 

verify compliance with the personnel 

requirements. Information on personnel 

qualifications of all technical personnel 

is needed to ensure the sample is 

representative of the entire laboratory; 

Form Number: CMS–209 (OCN 0938– 

0151); Frequency: Biennially; Affected 

Public: Private Sector; State, Local, or 

Tribal Governments; and Federal 

Government; Number of Respondents: 

20,486; Total Annual Responses: 

10,243; Total Annual Hours: 5,121.50. 

(For policy questions regarding this 

collection contact Kathleen Todd at 

(410) 786–3385. 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 

mstockstill on DSK4VPTVN1PROD with NOTICES

Federal Register / Vol. 76, No. 229 / Tuesday, November 29, 2011 / Notices 73649 

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. 

In commenting on the proposed 

information collections please reference 

the document identifier or OMB control 

number. To be assured consideration, 

comments and recommendations must 

be submitted in one of the following 

ways by January 30, 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/OMB 

Control Number lll_l, Room C4– 

26–05, 7500 Security Boulevard, 

Baltimore, Maryland 21244–1850. 

Dated: November 21, 2011. 

Martique Jones, 

Director, Regulations Development Group, 

Division B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2011–30729 Filed 11–28–11; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–10411, CMS– 

10114 and CMS–10390] 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

AGENCY: Centers for Medicare & 

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 & 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 function; 

(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. 

1. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: State Balancing 

Incentive Payments Program (BIPP); 

Use: The Balancing Incentive Program 

requires that States undertake three 

structural changes to their long-term 

services and supports (LTSS) systems to 

increase nursing home diversions and 

access to community-based care: 

implementation of a No Wrong Door/ 

Single Entry Point System, conflict-free 

case management, and the use of a core 

standardized assessment for supporting 

eligibility determination and service 

planning. In addition, grantee States 

must increase their community-based 

LTSS expenditures relative to their 

overall expenditures on LTSS to a 

minimum of 25% or 50%. State 

Medicaid agencies are responsible for 

developing the submissions to CMS in 

order to participate in this opportunity. 

If the statutory requirements are met, 

CMS will approve the State’s 

submission, giving the State the 

authority to implement the changes in 

the program and to draw down the 

increased FMAP funds. Form Number: 

CMS–10411 (OCN 0938–1145); 

Frequency: Once; Affected Public: State, 

Local, or Tribal Government; Number of 

Respondents: 56; Total Annual 

Responses: 56; Total Annual Hours: 

2,240. (For policy questions regarding 

this collection contact Effie George at 

(410) 786–8639. For all other issues call 

(410) 786–1326.) 

2. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: National 

Provider Identifier (NPI) Application 

and Update Form and Supporting 

Regulations in 45 CFR 142.408, 45 CFR 

162.406, 45 CFR 162.408; Use: The 

National Provider Identifier (NPI) 

Application and Update Form is used 

by health care providers to apply for 

NPIs and furnish updates to the 

information they supplied on their 

initial applications. The form is also 

used to deactivate their NPIs if 

necessary. The NPI Application/Update 

form has been revised to provide 

additional guidance on how to 

accurately complete the form. This 

collection includes clarification on 

information that is required on initial 

applications. Minor changes include 

adding a ‘delete’ check box for removal 

of information. This collection also 

includes revisions to the instructions. In 

addition, we have adjusted the burden 

downward from the estimate provided 

in the 60-day Federal Register notice to 

correct an arithmetic error. Form 

Number: CMS–10114 (OCN: 0938– 

0931); Frequency: Reporting—On 

occasion; Affected Public: Business or 

other for-profit, Not-for-profit 

institutions, and Federal government; 

Number of Respondents: 481,440; Total 

Annual Responses: 481,440; Total 

Annual Hours: 89,080. (For policy 

questions regarding this collection 

contact Leslie Jones at (410) 786–6599. 

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

3. Type of Information Collection 

Request: New collection; Title of 

Information Collection: Hospice 

Voluntary Quality Data Reporting 

Program; Use: Section 1814(i)(5) of the 

Social Security Act (Act) added by 

section 3004 of Patient Protection and 

Affordable Care Act, Public Law 111– 

148, enacted on March 23, 2010 

(Affordable Care Act), authorizes the 

Secretary to establish a quality reporting 

program for hospices. Section 

1814(i)(5)(A)(i) of the Act requires that 

the Secretary, beginning with FY 2014, 

reduce the market basket update by 2 

percentage points for any hospice that 

does not comply with the quality data 

submission requirements with respect to 

that fiscal year. 

To meet the quality reporting 

requirements for hospices, as set forth in 

the proposed Hospice Wage Index for 

Fiscal Year 2012 rule, we propose that 

there shall be a voluntary hospice 

quality reporting cycle which will 

consist of data collection cycle 

beginning on October 1, 2011 and 

continuing through December 31, 2011. 

This data shall be reported to CMS by 

no later than January 31, 2012. There 

shall be a mandatory hospice quality 

reporting cycle which will consist of 

data collected from October 1, 2012 

through December 31, 2012. This data 

shall be reported to CMS by no later 

than April 1, 2013. Thereafter, it is 

proposed that all subsequent hospice 

quality reporting cycles will be based on 

the calendar-year basis (that is, January 

1, 2013 through December 31, 2013 for 

determination of the Hospice market 

basket increase factor for each Hospice 

in FY 2015, etc.). 

We are requesting an initial approval 

of a data collection instrument entitled 

‘‘Quality Data Submission Form’’ that 

hospice providers will use to submit 

quality measures data to CMS during 

the proposed voluntary reporting period 

of 10/01/2011 through 12/31/2011. This 

form shall be used by hospices to report 

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