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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Federal Register / Vol. 78, No. 8 / Friday, January 11, 2013 / Notices 2413 

disclosure of protected health 

information. 

45 CFR 164.528 and 45 CFR 5b.9(c): 

This provision requires covered entities 

to permit individuals to request that the 

covered entity provide an accounting of 

disclosures of protected health 

information made by the covered entity. 

The form IHS–913, ‘‘Request for an 

Accounting of Disclosures,’’ is used to 

document an individual’s request for an 

accounting of disclosures of their 

protected health information and the 

agency’s handling of the request. 

45 CFR 164.526: This provision 

requires covered entities to permit an 

individual to request that the covered 

entity amend protected health 

information. If the covered entity 

accepts the requested amendment, in 

whole or in part, the covered entity 

must inform the individual that the 

amendment is accepted. If the covered 

entity denies the requested amendment, 

in whole or in part, the covered entity 

must provide the individual with a 

written denial. The form IHS–917, 

‘‘Request for Correction/Amendment of 

Protected Health Information,’’ will be 

used to document an individual’s 

request to amend their protected health 

information and the agency’s decision to 

accept or deny the request. 

Completed forms used in this 

collection of information are filed in the 

IHS medical, health and billing record, 

a Privacy Act System of Records Notice. 

Affected Public: Individuals and 

households. Type of Respondents: 

Individuals. Burden Hours: The table 

below provides the estimated burden 

hours for this information collection: 

Data collection instrument Number of 

respondents 

Responses 

per 

respondent 

Average 

burden hour 

per 

response * 

Total 

annual 

burden 

hours 

Authorization for Use or Disclosure of Protected Health Information (OMB 

Form No. 0917–0030, IHS–810) .................................................................. 500,000 1 20/60 166,667 

Request for Restriction(s) (OMB Form No. 0917–0030, IHS–912–1) ............ 15,000 1 10/60 2,500 

Request for Revocation of Restriction(s) (OMB Form No. 0917–0030, IHS– 

912–2) .......................................................................................................... 5,000 1 10/60 833 

Request for Accounting of Disclosures (OMB Form No. 0917–0030, IHS– 

913) .............................................................................................................. 15,000 1 10/60 2,500 

Request for Correction/Amendment of Protected Health Information (OMB 

Form No. 0917–0030, IHS–917) .................................................................. 7,500 1 15/60 1,875 

Total Annual Burden ................................................................................. ........................ 5 ........................ 174,375 

* For ease of understanding, burden hours are provided in actual minutes. 

The total estimated burden for this 

collection of information is 174,375 

hours. There are no capital costs, 

operating costs and/or maintenance 

costs to respondents. 

Request for Comments: Your written 

comments and/or suggestions are 

invited on one or more of the following 

points: (a) Whether the information 

collection activity is necessary to carry 

out an agency function; (b) whether the 

agency processes the information 

collected in a useful and timely fashion; 

(c) the accuracy of public burden 

estimate (the estimated amount of time 

needed for individual respondents to 

provide the requested information); (d) 

whether the methodology and 

assumptions used to determine the 

estimate are logical; (e) ways to enhance 

the quality, utility, and clarity of the 

information being collected; and (f) 

ways to minimize the public burden 

through the use of automated, 

electronic, mechanical, or other 

technological collection techniques or 

other forms of information technology. 

Direct your comments to OMB: Send 

your comments and suggestions 

regarding the proposed information 

collection contained in this notice, 

especially regarding the estimated 

public burden and associated response 

time to: Office of Management and 

Budget, Office of Regulatory Affairs, 

New Executive Office Building, Room 

10235, Washington, DC 20503, 

Attention: Desk Officer for IHS. 

To request more information on the 

proposed collection, or to obtain a copy 

of the data collection instruments and/ 

or instruction(s) contact: Tamara Clay, 

Reports Clearance Officer, 801 

Thompson Avenue, TMP, Suite 450, 

Rockville, MD 20852, call non-toll free 

(301) 443–4750, send via facsimile to 

(301) 443–2316, or send your email 

requests, comments, and return address 

to: Tamara.Clay@ihs.gov. 

Comment Due Date: February 11, 

2013. Your comments regarding this 

information collection are best assured 

of having full effect if received within 

30 days of the date of this publication. 

Dated: December 27, 2012. 

Yvette Roubideaux, 

Director, Indian Health Service. 

[FR Doc. 2013–00363 Filed 1–10–13; 8:45 am] 

BILLING CODE 4165–16–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Indian Health Service 

Office of Urban Indian Health 

Programs; Announcement Type: 

Meeting Notice 

AGENCY: Indian Health Service, HHS. 

ACTION: Meeting Notice. 

SUMMARY: The purpose of this Notice is 

to announce an Indian Health Service 

(IHS) Listening Session on the draft 

Policy on Conferring with Urban Indian 

Organizations (UIOs). IHS will provide 

an opportunity for interested parties to 

provide oral comments on the draft 

Policy on Conferring with UIOs that was 

published in the Federal Register on 

July 26, 2012. 

Name of Listening Session: IHS Urban 

Listening Session. 

Type of Meeting: Open Listening 

Session. 

DATES: January 22, 2013. 

Time: 1 p.m. to 3 p.m. Eastern Time— 

Approximate end time. 

ADDRESSES: The Listening Session will 

be held at: Indian Health Service 

Headquarters, 801 Thompson Avenue, 

Rhoades Conference Center, Reyes 

Building 4th floor, Rockville, MD 20852. 

SUPPLEMENTARY INFORMATION: The link 

to the Federal Register is: https://

www.federalregister.gov/articles/2012/

07/26/2012-18300/draft-policy-onconferring-with-urban-indianorganizations. Information about the 

Urban Indian health program and a 

registration link for this Listening 

Session are available on the IHS Web 

site: www.ihs.gov. 

Cost: There is no cost to attend the 

Listening Session. 

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