Federal Register / Vol. 78, No. 8 / Friday, January 11, 2013 / Notices 2411 

Estimated Total Annual Burden 

Hours: 8,204. 

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 

comments and suggestions submitted 

within 60 days of this publication. 

Robert Sargis, 

Reports Clearance Officer. 

[FR Doc. 2013–00416 Filed 1–10–13; 8:45 am] 

BILLING CODE 4184–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Health Resources and Services 

Administration 

Agency Information Collection 

Activities: Proposed Collection: 

Comment Request 

ACTION: Notice. 

SUMMARY: In compliance with the 

requirement for opportunity for public 

comment on proposed data collection 

projects (section 3506(c)(2)(A) of Title 

44, United States Code, as amended by 

the Paperwork Reduction Act of 1995, 

Pub. L. 104–13), the Health Resources 

and Services Administration (HRSA) 

publishes periodic summaries of 

proposed projects being developed for 

submission to the Office of Management 

and Budget (OMB) under the Paperwork 

Reduction Act of 1995. To request more 

information on the proposed project or 

to obtain a copy of the data collection 

plans and draft instruments, email 

paperwork@hrsa.gov or call the HRSA 

Reports Clearance Officer at (301) 443– 

1984. 

HRSA especially requests comments 

on: (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. 

Information Collection Request Title: 

Patient Survey-Health Centers (OMB 

No. 0915–xxxx) NEW. 

The Health Center program supports 

Health Centers (HCs), Migrant Health 

Centers (MHCs), Health Care for the 

Homeless (HCH) programs, and Public 

Housing Primary Care (PHPC) programs. 

Health Centers (HCs) receive grants from 

HRSA to provide primary and 

preventive health care services to 

medically underserved populations. 

The proposed Patient Survey will 

collect nationally in-depth information 

about HC patients, their health status, 

the reasons they seek care at the HCs, 

their diagnoses, the services they utilize 

at HCs and elsewhere, the quality of 

those services, and their satisfaction 

with the care they receive, through 

personal interviews of a stratified 

random sample of HC patients. Prior to 

the national study, a cognitive pre-test 

will be conducted to refine and test the 

survey instrument in different 

languages, and to test the survey 

sampling methodologies and 

procedures. The pre-test will include 

cognitive interviews to ensure that the 

questions are being understood as was 

intended. Interviews conducted in the 

pre-test and the national study are 

estimated to take approximately 1 hour 

and 15 minutes each. 

The Patient Survey builds on previous 

periodic Patient User-Visit Surveys, 

which were conducted to learn about 

the process and outcomes of care in HCs 

and MHCs, HCHs, and PHPCs. The 

original questionnaires were derived 

from the National Health Interview 

Survey (NHIS) and the National 

Ambulatory Medical Care Survey 

(NAMCS) conducted by the National 

Center for Health Statistics (NCHS). 

Conformance with the NHIS and 

NAMCS allowed comparisons between 

these NCHS surveys and the previous 

HC and HCH User-Visit Surveys. The 

new Patient Survey was developed 

using a questionnaire methodology 

similar to that used in the past and will 

also potentially allow some longitudinal 

comparisons for HCs and HCHs with the 

previous User-Visit survey data, 

including monitoring of processes and 

outcomes over time. In addition, this 

survey will be conducted in languages 

not used during previous surveys 

(which were conducted in English and 

Spanish) to include patients from 

different racial and ethnic backgrounds, 

including Chinese (Mandarin and 

Cantonese), Korean, and Vietnamese. 

With the exception of Spanish speakers, 

other racial and ethnic subgroups were 

not able to participate in the previous 

surveys. 

Burden Statement: Burden in this 

context means the time expended by 

persons to generate, maintain, retain, 

disclose or provide the information 

requested. This includes the time 

needed to review instructions, to 

develop, acquire, install and utilize 

technology and systems for the purpose 

of collecting, validating and verifying 

information, processing and 

maintaining information, and disclosing 

and providing information, to train 

personnel and to be able to respond to 

a collection of information, to search 

data sources, to complete and review 

the collection of information, and to 

transmit or otherwise disclose the 

information. The total annual burden 

hours estimated for this Information 

Collection Request are summarized in 

the table below. 

The annual estimate of burden is as 

follows: 

SURVEY PRETEST

Form name Number of 

respondents 

Number of 

responses per 

respondent 

Total 

responses 

Average 

burden per 

response 

(in hours) 

Total 

burden hours 

Grantee/Site Recruitment .................................................... 2 3 6 3.00 18.00 

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2412 Federal Register / Vol. 78, No. 8 / Friday, January 11, 2013 / Notices 

SURVEY PRETEST—Continued 

Form name Number of 

respondents 

Number of 

responses per 

respondent 

Total 

responses 

Average 

burden per 

response 

(in hours) 

Total 

burden hours 

Patient Recruitment (At clinic) ............................................. 21 1 21 .17 3.57 

Patient Survey (Administered at clinic) ................................ 16 1 16 1.25 20.00 

Patient Recruitment (Through local advertisements/flyers/ 

word-of-mouth) ................................................................. 71 1 71 .08 5.68 

Patient Survey (Administered following local advertising) ... 55 1 55 1.25 68.75 

Total Pretest ................................................................. ........................ ........................ ........................ ........................ 116.00 

NATIONAL STUDY

Form name Number of 

respondents 

Number of 

responses per 

respondent 

Total 

responses 

Average 

burden per 

response 

(in hours) 

Total 

burden hours 

Grantee/Site Recruitment and Training ............................... 165 3 495 3.75 1,856.25 

Patient Recruitment ............................................................. 9,207 1 9,207 .17 1,565.19 

Patient Survey ...................................................................... 6,600 1 6,600 1.25 8,250.00 

Total National Study ..................................................... ........................ ........................ ........................ ........................ 11,671.44 

Addresses: Submit your comments to 

paperwork@hrsa.gov or mail the HRSA 

Reports Clearance Officer, Room 10–29, 

Parklawn Building, 5600 Fishers Lane, 

Rockville, MD 20857. 

Deadline: Comments on this 

Information Collection Request must be 

received within 60 days of this notice. 

Dated: January 3, 2013. 

Bahar Niakan, 

Director, Division of Policy and Information 

Coordination. 

[FR Doc. 2013–00364 Filed 1–10–13; 8:45 am] 

BILLING CODE 4165–15–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Indian Health Service 

Request for Public Comment: 30-Day 

Proposed Information Collection: 

Indian Health Service Forms To 

Implement the Privacy Rule 

AGENCY: Indian Health Service, HHS. 

ACTION: Notice. 

SUMMARY: In compliance with Section 

3507(a)(1)(D) of the Paperwork 

Reduction Act of 1995 which requires 

30 days for public comment on 

proposed information collection 

projects, the Indian Health Service (IHS) 

is publishing for comment a summary of 

a proposed information collection to be 

submitted to the Office of Management 

and Budget (0MB) for review. This 

proposed information collection project 

was previously published in the Federal 

Register (77 FR 60219) on October 2, 

2012, and allowed 60 days for public 

comment, as required by 3506(c)(2)(A). 

No public comment was received in 

response to the notice. The purpose of 

this notice is to allow 30 days for public 

comment to be submitted directly to 

OMB. 

Proposed Collection: Title: 0917– 

0030, ‘‘IHS Forms to Implement the 

Privacy Rule (45 CFR parts 160 & 164).’’ 

Type of Information Collection Request: 

Extension, without revisions, of 

currently approved information 

collection, 0917–0030, ‘‘IHS Forms to 

Implement the Privacy Rule (45 CFR 

parts 160 & 164).’’ Form Number(s): 

IHS–810, IHS–912–1, IHS–912–2, IHS– 

913 and IHS–917. Need and Use of 

Information Collection: This collection 

of information is made necessary by the 

Department of Health and Human 

Services Rule entitled ‘‘Standards for 

Privacy of Individually Identifiable 

Health Information’’ (Privacy Rule) (45 

CFR parts 160 and 164). The Privacy 

Rule implements the privacy 

requirements of the Administrative 

Simplification subtitle of the Health 

Insurance Portability and 

Accountability Act of 1996, creates 

national standards to protect 

individuals’ personal health 

information, and gives patients 

increased access to their medical 

records. 45 CFR 164.508, 164.522, 

164.526 and 164.528 of the Rule require 

the collection of information to 

implement these protection standards 

and access requirements. The IHS will 

continue to use the following data 

collection instruments to meet the 

information collection requirements 

contained in the Rule. 

45 CFR 164.508: This provision 

requires covered entities to obtain or 

receive a valid authorization for its use 

or disclosure of protected health 

information for other than for treatment, 

payment and healthcare operations. 

Under the provision individuals may 

initiate a written authorization 

permitting covered entities to release 

their protected health information to 

entities of their choosing. The form 

IHS–810, ‘‘Authorization for Use or 

Disclosure of Protected Health 

Information,’’ is used to document an 

individual’s authorization to use or 

disclose their protected health 

information. 

45 CFR 164.522: Section 164.522(a)(1) 

requires a covered entity to permit 

individuals to request that the covered 

entity restrict the use and disclosure of 

their protected health information. The 

covered entity may or may not agree to 

the restriction. The form IHS–912–1, 

‘‘Request for Restrictions(s),’’ is used to 

document an individual’s request for 

restriction of their protected health 

information, and whether IHS agreed or 

disagreed with the restriction. Section 

164.522(a)(2) permits a covered entity to 

terminate its agreement to a restriction 

if the individual agrees to or requests 

the termination in writing. The form 

IHS–912–2, ‘‘Request for Revocation of 

Restriction(s),’’ is used to document the 

agency or individual request to 

terminate a formerly agreed to 

restriction regarding the use and 

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