### 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


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

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