84820 Federal Register / Vol. 88, No. 233 / Wednesday, December 6, 2023 / Notices 

immediate inspection at the Federal 

Reserve Bank(s) indicated below and at 

the offices of the Board of Governors. 

This information may also be obtained 

on an expedited basis, upon request, by 

contacting the appropriate Federal 

Reserve Bank and from the Board’s 

Freedom of Information Office at 

https://www.federalreserve.gov/foia/ 

request.htm. Interested persons may 

express their views in writing on the 

standards enumerated in paragraph 7 of 

the Act. 

Comments regarding each of these 

applications must be received at the 

Reserve Bank indicated or the offices of 

the Board of Governors, Ann E. 

Misback, Secretary of the Board, 20th 

Street and Constitution Avenue NW, 

Washington DC 20551–0001, not later 

than December 21, 2023. 

A. Federal Reserve Bank of Chicago 

(Colette A. Fried, Assistant Vice 

President) 230 South LaSalle Street, 

Chicago, Illinois 60690–1414. 

Comments can also be sent 

electronically to 

Comments.applications@chi.frb.org: 

1. Karen K. Spies, Graettinger, Iowa; 

to retain voting shares of Emmetsburg 

Bank Shares, Inc., and thereby 

indirectly retain voting shares of Iowa 

Trust & Savings Bank, both of 

Emmetsburg, Iowa. 

2. Andrew Prather and Tina Prather, 

both of Petersburg, Illinois; Elizabeth A. 

Prather, Virginia, Illinois; and the Laura 

J. Prather Trust, Laura J. Prather, 

trustee, both of Creve Coeur, Missouri; 

as members of the Prather Family 

Control Group, a group acting in 

concert, to retain voting shares of 

Petefish, Skiles Bancshares, Inc., and 

thereby indirectly retain voting shares of 

Petefish, Skiles & Company, both of 

Virginia, Illinois, and The First National 

Bank of Beardstown, Beardstown, 

Illinois. 

3. George Bley, II, and Michelle Bley, 

both of Palm Harbor, Florida; and Jan E. 

Rohde, Springfield, Illinois; as members 

of the Bley Family Control Group, a 

group acting in concert, to retain voting 

shares of Petefish, Skiles Bancshares, 

Inc. and thereby indirectly retain voting 

shares of Petefish, Skiles & Company, 

both of Virginia, Illinois, and The First 

National Bank of Beardstown, 

Beardstown, Illinois. 

Board of Governors of the Federal Reserve 

System. 

Michele Taylor Fennell, 

Deputy Associate Secretary of the Board. 

[FR Doc. 2023–26788 Filed 12–5–23; 8:45 am] 

BILLING CODE P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: Document Identifiers: 

CMS–1561 and CMS–1561A] 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, Health and Human 

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 

(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 

a second opportunity for public 

comment on the notice. Interested 

persons are invited to send comments 

regarding the burden estimate or any 

other aspect of this collection of 

information, including the necessity and 

utility of the proposed information 

collection for the proper performance of 

the agency’s functions, the accuracy of 

the estimated burden, ways to enhance 

the quality, utility, and clarity of the 

information to be collected, and the use 

of automated collection techniques or 

other forms of information technology to 

minimize the information collection 

burden. 

DATES: Comments on the collection(s) of 

information must be received by the 

OMB desk officer by January 5, 2024. 

ADDRESSES: Written comments and 

recommendations for the proposed 

information collection should be sent 

within 30 days of publication of this 

notice to www.reginfo.gov/public/do/ 

PRAMain. Find this particular 

information collection by selecting 

‘‘Currently under 30-day Review—Open 

for Public Comments’’ or by using the 

search function. 

To obtain copies of a supporting 

statement and any related forms for the 

proposed collection(s) summarized in 

this notice, please access the CMS PRA 

website by copying and pasting the 

following web address into your web 

browser: https://www.cms.gov/ 

Regulations-and-Guidance/Legislation/ 

PaperworkReductionActof1995/PRAListing. 

FOR FURTHER INFORMATION CONTACT: 

William Parham at (410) 786–4669. 

SUPPLEMENTARY INFORMATION: Under the 

Paperwork Reduction Act of 1995 (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 (44 U.S.C. 

3506(c)(2)(A)) requires federal agencies 

to publish a 30-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 that summarizes 

the following proposed collection(s) of 

information for public comment: 

1. Type of Information Collection 

Request: Reinstatement without change 

of a previously approved collection; 

Title of Information Collection: Health 

Insurance Benefit Agreement; Use: The 

CMS–1561 form applies to specific 

types of health care providers and 

opioid treatment programs and the 

CMS–1561A form applies to rural health 

clinics (RHCs). The CMS–1561 and 

CMS–1561A forms are health insurance 

benefits agreements that are essential for 

the Centers for Medicare and Medicaid 

Services (CMS) to ensure that applicants 

to the Medicare program have made a 

binding commitment to comply with all 

applicable Federal requirements. The 

CMS–1561/1561A forms are essential in 

that they allow CMS to ensure that 

applicants are in compliance with the 

requirements. Applicants will be 

required to sign the completed form and 

provide operational information to CMS 

to assure that they continue to meet the 

requirements after approval. The 

collection is made only once, when the 

provider or RHC submits their 

application for participation in 

Medicare by signing the completed 

CMS–1561 or CMS–1561A form (as 

applicable). Form Number: CMS–1561/ 

1561A (OMB control number: 0938– 

0832); Frequency: Once only; Affected 

Public: Private sector—(Business or 

other for-profits and Not-for-profit 

institutions); Number of Respondents: 

2,050; Total Annual Responses: 2,050; 

Total Annual Hours: 2,050. (For policy 

questions regarding this collection 


lotter on DSK11XQN23PROD with NOTICES1
Federal Register / Vol. 88, No. 233 / Wednesday, December 6, 2023 / Notices 84821 

contact Caroline Gallaher at 410–786– 

8705). 

Dated: November 30, 2023. 

William N. Parham, III, 

Director, Paperwork Reduction Staff, Office 

of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2023–26738 Filed 12–5–23; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Submission for (Office of Management 

and Budget (OMB) Review; Sexual 

Risk Avoidance Education Program 

Performance Analysis Study— 

Extension OMB #0970–0536) 

AGENCY: Office of Planning, Research, 

and Evaluation, Administration for 

Children and Families, Department of 

Health and Human Services. 

ACTION: Request for public comments. 

SUMMARY: The Office of Planning, 

Research, and Evaluation (OPRE) and 

the Family and Youth Services Bureau 

in the Administration for Children and 

Families (ACF) request an extension 

without changes to a currently approved 

information collection activity as part of 

the Sexual Risk Avoidance Education 

(SRAE) Program Performance Analysis 

Study (PAS). The goal of the study is to 

collect, analyze, and report on 

performance measures data for the 

SRAE program (OMB Control No. 0970– 

0536; expiration date 12/31/2023). The 

purpose of the requested extension is to 

continue the ongoing data collection 

and submission of the performance 

measures by SRAE grantees. Materials 

under the submission will be updated to 

reflect only surveys currently in use. 

DATES: Comments due within 30 days of 

publication. OMB must make a decision 

about the collection of information 

between 30 and 60 days after 

publication of this document in the 

Federal Register. Therefore, a comment 

is best assured of having its full effect 

if OMB receives it within 30 days of 

publication. 

ADDRESSES: Written comments and 

recommendations for the proposed 

information collection should be sent 

within 30 days of publication of this 

notice to www.reginfo.gov/public/do/ 

PRAMain. Find this particular 

information collection by selecting 

‘‘Currently under 30-day Review—Open 

for Public Comments’’ or by using the 

search function. You can also obtain 

copies of the proposed collection of 

information by emailing 

OPREinfocollection@acf.hhs.gov. 

Identify all requests by the title of the 

information collection. 

SUPPLEMENTARY INFORMATION: 

Description: The purpose of the SRAE 

program is to educate youth on how to 

voluntarily refrain from nonmarital 

sexual activity and prevent other youth 

risk behaviors. Data will continue to be 

used to determine if the SRAE grantees 

are meeting performance benchmarks 

related to their program’s mission and 

priorities. 

The SRAE PAS collects performance 

measures data from SRAE grantees, 

program providers, and participants. 

The data include information on 

program structure, cost, and support for 

implementation; program attendance, 

reach, and dosage; the characteristics of 

youth involved in programming; youth 

sexual and other risky behavior prior to 

program participation; and youth sexual 

and other risky behavior intentions at 

program exit. The performance 

measures help the ACF program office 

and grantees to monitor and report on 

progress in implementing SRAE 

programs and inform technical 

assistance. 

Some of the performance measures 

data come from youth participants 

through surveys SRAE grantees 

administer at program entry and exit. 

There are separate versions of the entry 

and exit surveys for middle school 

youth, which exclude some of the more 

sensitive items that are included in the 

versions for high school and older 

youth. There is also a shorter version of 

the entry survey for programs 

conducting impact studies, to reduce 

the burden on participants in those 

programs who are likely responding to 

other surveys as part of their impact 

study. Although there was a version of 

the exit survey for programs conducting 

impact studies in the past, youth in 

these programs complete the same 

version of the exit survey as other 

youth. As the shorter exit surveys are no 

longer in use, they will be removed 

through this request. 

Respondents: General Departmental 

(GDSRAE), State (SSRAE), and 

Competitive (CSRAE) grantees, their 

subrecipients, and program participants. 

ANNUAL BURDEN ESTIMATES

Instrument 

Number of 

respondents 

(total over 

request 

period) 

Number of 

responses per 

respondent 

(total over 

request 

period) 

Avg. burden 

per response 

(in hours) 

Total burden 

(in hours) 

Annual burden 

(in hours) 

(1) Participant Entry Survey 

GDSRAE participants .......................................................... 378,390 1 0.1333 50,439 16,813 

SSRAE participants ............................................................. 952,899 1 0.1333 127,021 42,340 

CSRAE participants ............................................................. 60,408 1 0.1333 8,052 2,684 

(2) Participant Exit Survey 

GDSRAE participants .......................................................... 302,712 1 0.1667 50,462 16,821 

SSRAE participants ............................................................. 762,319 1 0.1667 127,079 42,360 

CSRAE participants ............................................................. 48,326 1 0.1667 8,056 2,685 

(3) Performance reporting data entry form: grantees 

GDSRAE grantees ............................................................... 119 6 16 11,424 3,808 

SSRAE grantees .................................................................. 39 6 16 3,744 1,248 

CSRAE grantees .................................................................. 34 6 16 3,264 1,088 


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