35982 Federal Register / Vol. 77, No. 116 / Friday, June 15, 2012 / Notices 

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: Extension of a currently 

approved collection; Title of 

Information Collection: State Health 

Insurance Assistance Program (SHIP) 

Client Contact Form, Public and Media 

Activity Report Form, and Resource 

Report Form. Use: Section 4360(f) of the 

Omnibus Budget Reconciliation Act 

(OBRA) 1990 requires the Secretary to 

provide a series of reports to the U.S. 

Congress on the performance of the 

program and its impact on beneficiaries 

and to obtain important informational 

feedback from beneficiaries. Further, in 

response to requirements of the 

Balanced Budget Act of 1997, CMS 

launched a comprehensive five-year 

campaign, the National Medicare 

Education Program (NMEP), to raise 

awareness among beneficiaries about 

their Medicare health plan options and 

help them assess the advantages and 

disadvantages each choice holds for 

them. The Medicare Modernization Act 

(MMA) of 2003 required State Health 

Insurance Assistance Programs (SHIPs) 

to be actively engaged in the 

implementation of the Medicare 

Prescription Drug Program (Part D). 

MIPPA legislation and Affordable Care 

Act legislation required SHIPs to 

provide enrollment assistance for the 

Limited Income Subsidy (LIS) and 

Medicare Savings Program (MSP). The 

goal is to ensure that beneficiaries are 

making an informed choice, regardless 

of whether they stay in Original 

Medicare or choose new options. CMS 

is responsible to Congress for 

demonstrating improvement over time 

in the level of awareness and 

understanding beneficiaries have about 

health plan options. The SHIPs are an 

integral component of this initiative. 

The information collected is used to 

fulfill the reporting requirements 

described in Section 4360(f) of OBRA 

1990. The data will be accumulated and 

analyzed to measure SHIP performance 

in order to determine whether and to 

what extent the SHIPs have met the 

goals of improved CMS customer 

service to beneficiaries and better 

understanding by beneficiaries of their 

health insurance options. Further, the 

information will be used in the 

administration of the grants, to measure 

performance and appropriate use of the 

funds by the state grantees, to identify 

gaps in services and technical support 

needed by SHIPs, and to identify and 

share best practices. 

The overall burden of hours and 

expected number of respondents 

increase is based on projected future 

service growth and projected future 

increases in staffing to accommodate the 

increased demand to utilize the SHIP 

network to raise awareness about new 

CMS policies, outreach initiatives, or 

both. Form Number: CMS–10028 (OCN: 

0938–0850); Frequency: Occasionally; 

Affected Public: State, Local, or Tribal 

Governments; Number of Respondents: 

17,838; Total Annual Responses: 

2,346,465. Total Annual Hours: 195,642. 

(For policy questions regarding this 

collection contact Letticia Ramsey at 

410–786–5262. 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 

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 August 14, 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 CMS– 

10434, Room C4–26–05, 7500 Security 

Boulevard, Baltimore, Maryland 21244– 

1850. 

Dated: June 12, 2012. 

Martique Jones, 

Director, Regulations Development Group, 

Division B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2012–14674 Filed 6–14–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10221, CMS– 

855I and CMS–855R] 

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: Reinstatement without change 

of a previously approved collection; 

Title of Information Collection: 

Worksheet for Recording Results of 

Medicare Site Visits of Independent 

Diagnostic Testing Facilities (IDTFs); 

Use: The worksheet (form) was 

developed, approved through the Office 

of Management and Budget and 

implemented to allow for CMS to have 

a standard format to collect and verify 

information regarding the compliance of 

independent diagnostic testing facilities 

(IDTFs) with the performance standards 

found in 42 CFR 410.33(g). This 

previously approved form was allowed 

to expire in error. CMS is now seeking 

re-instatement of the use of this form. 

The worksheet is used to collect and 

record information obtained on IDTF 

site visits; the data collected during site 


srobinson on DSK4SPTVN1PROD with NOTICES
Federal Register / Vol. 77, No. 116 / Friday, June 15, 2012 / Notices 35983 

visits facilitates the verification of the 

accuracy and completeness of the 

information the IDTF furnished on its 

CMS–855B enrollment application. The 

worksheet is completed by CMS or its 

contractors. Some of the answers to the 

questions/data elements on the 

worksheet are verbally furnished by the 

IDTF during the site visit; Form 

Number: CMS–10221 (OCN 0938–1029); 

Frequency: Occasionally; Affected 

Public: Private Sector (Business or other 

for-profits); Number of Respondents: 

2,000; Total Annual Responses: 2,000; 

Total Annual Hours: 4,000. (For policy 

questions regarding this collection 

contact Michael Collett at 410–786– 

6121. For all other issues call 410–786– 

1326.) 

2. Type of Information Collection 

Request: Revision of a currently 

approved collection. Title of 

Information Collection: Medicare 

Enrollment Application for Physician 

and Non-Physician Practitioners. Use: 

Health care practitioners who wish to 

enroll in the Medicare program must 

complete the CMS 855I enrollment 

application. It is submitted at the time 

the applicant first requests a Medicare 

billing number. The application is used 

by the Medicare Administrative 

Contractor (MAC), to collect data to 

assure the applicant has the necessary 

professional and/or business credentials 

to provide the health care services for 

which they intend to bill Medicare 

including information that allows the 

MAC to correctly price, process and pay 

the applicant’s claims. It also gathers 

information that allows the MAC to 

ensure that the practitioner is not 

sanctioned from the Medicare program, 

or debarred, suspended or excluded 

from any other Federal agency or 

program. Form Number: CMS–855I 

(OCN: 0938–0685). Frequency: Once 

and Occasionally. Affected Public: 

Private Sector (Business or other forprofit and not-for-profit institutions). 

Number of Respondents: 345,000. Total 

Annual Responses: 345,000. Total 

Annual Hours: 824,000. (For policy 

questions regarding this collection 

contact Kimberly McPhillips at 410– 

786–5374. For all other issues call 410– 

786–1326.) 

3. Type of Information Collection 

Request: New collection. Title of 

Information Collection: Medicare 

Enrollment Application—Reassignment 

of Medicare Benefits. Use: Health care 

practitioners who wish to reassign their 

benefits in the Medicare program must 

complete the CMS 855R enrollment 

application. It is submitted at the time 

the physician or non-physician 

practitioner first requests reassignment 

of his/her Medicare benefits to a group 

practice, as well as any subsequent 

reassignments or terminations of 

established reassignments as requested 

by the physician or non-physician 

practitioner. The application is used by 

the Medicare Administrative Contractor 

(MAC) to collect data to assure the 

applicant has the necessary information 

that allows the MAC to correctly 

establish or terminate the reassignment. 

Form Number: CMS–855R (OCN: 0938– 

New). Frequency: Occasionally. 

Affected Public: Private Sector (Business 

or other for-profit and not-for-profit 

institutions). Number of Respondents: 

100,000. Total Annual Responses: 

100,000. Total Annual Hours: 50,000. 

(For policy questions regarding this 

collection contact Kimberly McPhillips 

at 410–786–5374. 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 

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. 

To be assured consideration, 

comments and recommendations for the 

proposed information collections must 

be received by the OMB desk officer at 

the address below, no later than 5 p.m. 

on July 16, 2012. 

OMB, Office of Information and 

Regulatory Affairs, Attention: CMS 

Desk Officer, Fax Number: (202) 395– 

6974, Email: 

OIRA_submission@omb.eop.gov. 

Dated: June 12, 2012. 

Martique Jones, 

Director, Regulations Development Group, 

Division B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2012–14673 Filed 6–14–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Food and Drug Administration 

[Docket No. FDA–2012–N–0593] 

Agency Information Collection 

Activities; Proposed Collection; 

Comment Request; Eye Tracking 

Experimental Studies To Explore 

Consumer Use of Food Labeling 

Information and Consumer Response 

to Online Surveys 

AGENCY: Food and Drug Administration, 

HHS. 

ACTION: Notice. 

SUMMARY: The Food and Drug 

Administration (FDA) is announcing an 

opportunity for public comment on the 

proposed collection of certain 

information by the Agency. Under the 

Paperwork Reduction Act of 1995 (the 

PRA), Federal Agencies are required to 

publish notice in the Federal Register 

concerning each proposed collection of 

information and to allow 60 days for 

public comment in response to the 

notice. This notice solicits comments on 

a study entitled ‘‘Eye Tracking 

Experimental Studies to Explore 

Consumer Use of Food Labeling 

Information and Consumer Response to 

Online Surveys.’’ 

DATES: Submit either electronic or 

written comments on the collection of 

information by August 14, 2012. 

ADDRESSES: Submit electronic 

comments on the collection of 

information to http:// 

www.regulations.gov. Submit written 

comments on the collection of 

information to the Division of Dockets 

Management (HFA–305), Food and Drug 

Administration, 5630 Fishers Lane, Rm. 

1061, Rockville, MD 20852. All 

comments should be identified with the 

docket number found in brackets in the 

heading of this document. 

FOR FURTHER INFORMATION CONTACT: 

Domini Bean, Office of Information 

Management, Food and Drug 

Administration, 1350 Piccard Dr., PI50– 

400T, Rockville, MD 20850, 

domini.bean@fda.hhs.gov. 

SUPPLEMENTARY INFORMATION: Under the 

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. 

‘‘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. 


srobinson on DSK4SPTVN1PROD with NOTICES