Federal Register / Vol. 79, No. 67 / Tuesday, April 8, 2014 / Notices 19341 

Services (HHS) as a final rule, advice on 

methods of dose reconstruction which 

have also been promulgated by HHS as 

a final rule, advice on the scientific 

validity and quality of dose estimation 

and reconstruction efforts being 

performed for purposes of the 

compensation program, and advice on 

petitions to add classes of workers to the 

Special Exposure Cohort (SEC). 

In December 2000, the President 

delegated responsibility for funding, 

staffing, and operating the Advisory 

Board to HHS, which subsequently 

delegated this authority to the CDC. 

NIOSH implements this responsibility 

for CDC. The charter was issued on 

August 3, 2001, renewed at appropriate 

intervals, and will expire on August 3, 

2015. 

Purpose: This Advisory Board is 

charged with (a) providing advice to the 

Secretary, HHS, on the development of 

guidelines under Executive Order 

13179; (b) providing advice to the 

Secretary, HHS, on the scientific 

validity and quality of dose 

reconstruction efforts performed for this 

program; and (c) upon request by the 

Secretary, HHS, advise the Secretary on 

whether there is a class of employees at 

any Department of Energy facility who 

were exposed to radiation but for whom 

it is not feasible to estimate their 

radiation dose, and on whether there is 

reasonable likelihood that such 

radiation doses may have endangered 

the health of members of this class. 

Matters for Discussion: The agenda for 

the Advisory Board meeting includes: 

NIOSH Program Update; Department of 

Labor Program Update; Department of 

Energy Program Update; SEC petitions 

for: Nuclear Metal Inc. (West Concord, 

MA), Joslyn Manufacturing and Supply 

Company (Fort Wayne, IN) and 

Savannah River Site (Aiken, SC); SEC 

Issues Work Group Report on 

‘‘Sufficient Accuracy’’/Co-Worker Dose 

Modeling; SEC Petitions Update; and 

Board Work Session. 

The agenda is subject to change as 

priorities dictate. 

In the event an individual cannot 

attend, written comments may be 

submitted in accordance with the 

redaction policy provided below. Any 

written comments received will be 

provided at the meeting and should be 

submitted to the contact person below 

well in advance of the meeting. 

Policy on Redaction of Board Meeting 

Transcripts (Public Comment): (1) If a 

person making a comment gives his or 

her personal information, no attempt 

will be made to redact the name; 

however, NIOSH will redact other 

personally identifiable information, 

such as contact information, social 

security numbers, case numbers, etc., of 

the commenter. 

(2) If an individual in making a 

statement reveals personal information 

(e.g., medical or employment 

information) about themselves that 

information will not usually be 

redacted. The NIOSH Freedom of 

Information Act (FOIA) coordinator 

will, however, review such revelations 

in accordance with the Federal 

Advisory Committee Act and if deemed 

appropriate, will redact such 

information. 

(3) If a commenter reveals personal 

information concerning a living third 

party, that information will be reviewed 

by the NIOSH FOIA coordinator, and 

upon determination, if deemed 

appropriated, such information will be 

redacted, unless the disclosure is made 

by the third party’s authorized 

representative under the Energy 

Employees Occupational Illness 

Compensation Program Act (EEOICPA) 

program. 

(4) In general, information concerning 

a deceased third party may be disclosed; 

however, such information will be 

redacted if (a) the disclosure is made by 

an individual other than the survivor 

claimant, a parent, spouse, or child, or 

the authorized representative of the 

deceased third party; (b) if it is unclear 

whether the third party is living or 

deceased; or (c) the information is 

unrelated or irrelevant to the purpose of 

the disclosure. 

The Board will take reasonable steps 

to ensure that individuals making 

public comment are aware of the fact 

that their comments (including their 

name, if provided) will appear in a 

transcript of the meeting posted on a 

public Web site. Such reasonable steps 

include: (a) A statement read at the start 

of each public comment period stating 

that transcripts will be posted and 

names of speakers will not be redacted; 

(b) A printed copy of the statement 

mentioned in (a) above will be 

displayed on the table where 

individuals sign up to make public 

comments; (c) A statement such as 

outlined in (a) above will also appear 

with the agenda for a Board Meeting 

when it is posted on the NIOSH Web 

site; (d) A statement such as in (a) above 

will appear in the Federal Register 

Notice that announces Board and 

Subcommittee meetings. 

Contact Person For More Information: 

Theodore Katz, M.P.A., Designated 

Federal Officer, NIOSH, CDC, 1600 

Clifton Road NE., MS E–20, Atlanta GA 

30333, Telephone: (513) 533–6800, Toll 

Free: 1–800–CDC–INFO, Email: dcas@

cdc.gov 

The Director, Management Analysis 

and Services Office, has been delegated 

the authority to sign Federal Register 

Notices pertaining to announcements of 

meetings and other committee 

management activities, for both the 

Centers for Disease Control and 

Prevention and the Agency for Toxic 

Substances and Disease Registry. 

Elaine L. Baker, 

Director, Management Analysis and Services 

Office, Centers for Disease Control and 

Prevention. 

[FR Doc. 2014–07773 Filed 4–7–14; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

Privacy Act of 1974, Report of New 

System of Records 

AGENCY: Department of Health and 

Human Services (HHS), Centers for 

Medicare & Medicaid Services (CMS). 

ACTION: Notice of a New System of 

Records (SOR). 

SUMMARY: In accordance with the 

requirements of the Privacy Act of 1974, 

CMS is establishing a new SOR titled, 

‘‘Hospice Item Set (HIS) System,’’ 

System No. 09–70–0548. The new 

system will support the collection of 

data required for the Hospice Quality 

Reporting Program (HQRP) pursuant to 

Section 3004(c) of the Patient Protection 

and Affordable Care Act of 2010 (ACA) 

(Pub. L. 111–148), which amended the 

Social Security Act (the Act) (42 U.S.C. 

1814(i)). HIS is a standardized, patientlevel data collection vehicle consisting 

of data elements confirming that the 

appropriate assessments were made and 

inquiries or concerns were addressed for 

each patient at the time of admission for 

the following domains of care: (1) Pain; 

(2) Respiratory Status; (3) Medications; 

(4) Patient Preferences; and (5) Beliefs & 

Values. 

DATES: Effective Dates: Effective 30 days 

after publication. Written comments 

should be submitted on or before the 

effective date. HHS/CMS/CCSQ may 

publish an amended SORN in light of 

any comments received. 

ADDRESSES: The public should address 

comments to: CMS Privacy Officer, 

Privacy Policy Compliance Group, 

Office of E-Health Standards & Services, 

Office of Enterprise Management, 

Centers for Medicare & Medicaid 

Services, 7500 Security Boulevard, 

Baltimore, MD 21244–1870, Mailstop: 

S2–24–25, Office: (410) 786–5357, 

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19342 Federal Register / Vol. 79, No. 67 / Tuesday, April 8, 2014 / Notices 

Facsimile: (410) 786–1347, E-Mail: 

walter.stone@cms.hhs.gov. Comments 

received will be available for review at 

this location, by appointment, during 

regular business hours, Monday through 

Friday from 9:00 a.m.–3:00 p.m., Eastern 

Time zone. 

FOR FURTHER INFORMATION CONTACT: 

Caroline Gallaher, Nurse Consultant, 

CMS, Centers for Clinical Standards and 

Quality, Quality Measurement & Health 

Assessment Group, Division of Chronic 

& Post-Acute Care, 7500 Security 

Boulevard, Mail Stop S3–02–01, 

Baltimore, MD 21244–1850. Office: 410– 

786–8705, Facsimile: (410) 786–8532, 

Email address: caroline.gallaher@

cms.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

I. Background and Introduction 

Section 3004(c) of the ACA directed 

the Secretary of HHS to establish a 

quality reporting program for hospices 

for the purpose of collecting, compiling 

and eventually publishing data 

measuring the quality of care provided 

to patients receiving hospice care. The 

quality measure data is required to be 

valid, meaningful, and feasible to 

collect, and to address symptom 

management, patient preferences and 

care coordination. Although CMS 

administers the HIS, information is also 

collected on hospice patients who may 

not be Medicare beneficiaries. 

A hospice is a public agency or 

private organization or a subdivision of 

either that is primarily engaged in 

providing care to terminally ill 

individuals, meets the conditions of 

participation for hospices, and has a 

valid Medicare provider agreement. 

Hospice care is an approach to caring 

for terminally ill individuals that 

stresses palliative care (relief of pain 

and uncomfortable symptoms), as 

opposed to curative care. In addition to 

meeting the patient’s medical needs, 

hospice care addresses the physical, 

psychosocial, and spiritual needs of the 

patient, as well as the psychosocial 

needs of the patient’s family/caregiver. 

The HIS is not a patient assessment 

instrument and will not be administered 

to the patient and/or family or 

caregivers. In contrast, HIS is a 

standardized mechanism for abstracting 

data from the medical record. 

The HIS was developed specifically 

for use by hospices and contains data 

elements that can be used by CMS to 

collect the patient-level data required 

for seven National Quality Forum— 

(NQF) endorsed quality measures and a 

modification of one NQF-endorsed 

measure. These measures include: (1) 

Hospice and Palliative Care—Pain 

Screening (NQF #1634); (2) Hospice and 

Palliative Care—Pain Assessment (NQF 

#1637); (3) Hospice and Palliative 

Care—Dyspnea Screening (NQF #1639); 

(4) Hospice and Palliative Care— 

Dyspnea Treatment (NQF #1638); (5) 

Patients Treated With an Opioid who 

are Given a Bowel Regimen (NQF 

#1617); (6) Hospice and Palliative 

Care—Treatment Preferences (NQF 

#1641); and (7) Beliefs/values addressed 

(modified version of the NQF #1647 

measure). 

Hospices will begin using the HIS for 

all patients beginning July 1, 2014. 

Hospices will be required to submit two 

HIS records for each patient admitted to 

their organization—a HIS-Admission 

record and a HIS-Discharge record. The 

HIS-Admission contains both 

administrative items for patient 

identification and clinical items for 

calculating the seven quality measures. 

The HIS-Discharge is a limited set of 

administrative items also used for 

patient identification, as well as 

discharge information, which will be 

used primarily to determine patient 

exclusions for some of the seven quality 

measures. 

II. The Privacy Act 

The Privacy Act (5 U.S.C. 552a) 

governs the means by which the United 

States Government collects, maintains, 

and uses personally identifiable 

information (PII) in a SOR. A SOR is a 

group of any records under the control 

of a Federal agency from which 

information about individuals is 

retrieved by name or other personal 

identifier. The Privacy Act requires each 

agency to publish in the Federal 

Register a system of records notice 

(SORN) identifying and describing each 

system of records the agency maintains, 

including the purposes for which the 

agency uses information about 

individuals in the system, the routine 

uses for which the agency discloses 

such information outside the agency, 

and how individual record subjects can 

exercise their rights under the Privacy 

Act (e.g., to determine if the system 

contains information about them). 

System Number: 09–70–0548 

SYSTEM NAME: 

‘‘Hospice Item Set (HIS) System’’ 

HHS/CMS/CCSQ. 

SECURITY CLASSIFICATION: 

Unclassified. 

SYSTEM LOCATION: 

CMS Data Center, 7500 Security 

Boulevard, North Building, First Floor, 

Baltimore, Maryland 21244–1850, and 

at various Hospices and contractor sites. 

CATEGORIES OF INDIVIDUALS COVERED BY THE

SYSTEM: 

The system will contain information 

about the following categories of 

individuals who participate in or are 

involved with the HQRP: (1) Hospice 

patients and Medicare beneficiaries, 

who receive health care services 

coordinated and managed by hospices; 

and, (2) any individual providers and/ 

or any contact persons for a hospice 

whose personal information (such as, 

home or personal contact information, 

or Social Security Number (SSN) if used 

for business purposes) is provided as 

business-identifying information on the 

collection instrument. 

CATEGORIES OF RECORDS IN THE SYSTEM: 

Information in the HIS about hospice 

patients includes but not limited to 

information related to condition, 

selected covariates about the condition, 

and patient/beneficiary demographic 

records containing the patient/

beneficiary’s name, gender, beneficiary’s 

Health Insurance Claim Number (HICN), 

SSN, Medicaid number (MA number), 

race, and date of birth. Information 

collected about providers who work in 

hospices considered to be PII includes 

records containing the provider’s name, 

address, National Provider Identifier 

(NPI), and CMS Certification Number 

(CCN), personal contact information, tax 

identification number, and SSN if used 

for business purposes. 

AUTHORITY FOR MAINTENANCE OF THE SYSTEM: 

Authority for the SOR is given at 

Section 3004(c) of the Patient Protection 

and Affordable Care Act of 2010 (Pub. 

L. 111–148), amending the Social 

Security Act (42 U.S.C. 1814(i)). 

PURPOSE(S) OF THE SYSTEM: 

The purpose(s) of this SOR is to create 

a hospice item set that is used as a 

standardized mechanism for abstracting 

data from the medical record to address 

symptom management, patient 

preferences and care coordination; to 

house the data needed for the HQRP, 

and to maintain a quality reporting 

program for hospices for the purpose of 

collecting, compiling and eventually 

publishing data measuring the quality of 

care provided to patients receiving 

hospice care. CMS will or may use 

personally identifiable information from 

this system to: (1) Support regulatory, 

reimbursement, and policy functions 

performed by Agency contractors, 

consultants, or CMS grantees; (2) assist 

Federal and state agencies and their 

fiscal agents to perform the statutory 

functions of the HQRP; (3) assist 

hospices with the statutory reporting 

requirements; (4) support research, 

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Federal Register / Vol. 79, No. 67 / Tuesday, April 8, 2014 / Notices 19343 

evaluation, or epidemiological projects 

related to end of life care, and for 

payment related projects; (5) support the 

functions of Quality Improvement 

Organizations; (6) support the functions 

of national accrediting organizations; (7) 

support litigation involving the agency; 

(8) combat fraud, waste, and abuse in 

certain health benefits programs, (9) 

assist agencies, entities, contractors, or 

persons tasked with the response and 

remedial efforts in the event of a breach 

of information, and (10) assist the U.S. 

Department of Homeland Security 

(DHS) cyber security personnel. 

ROUTINE USES OF RECORDS MAINTAINED IN THE

SYSTEM, INCLUDING CATEGORIES OR USERS AND

THE PURPOSES OF SUCH USES: 

A. ENTITIES WHO MAY RECEIVE DISCLOSURES

UNDER ROUTINE USE

These routine uses specify 

circumstances, in addition to those 

provided by statute in the Privacy Act 

of 1974, under which CMS may release 

information from HIS without the 

consent of the individual to whom such 

information pertains. Each proposed 

disclosure of information under these 

routine uses will be evaluated to ensure 

that the disclosure is legally 

permissible, including but not limited to 

ensuring that the purpose of the 

disclosure is compatible with the 

purpose for which the information was 

collected. We propose to establish the 

following routine use disclosures of 

information maintained in the system: 

1. To support Agency contractors, 

consultants, or CMS grantees who have 

been engaged by the Agency to assist in 

accomplishment of a CMS function 

relating to the purposes for this 

collection and who need to have access 

to the records in order to assist CMS. 

2. To assist another Federal Agency, 

agency of a State government, an agency 

established by State law, or its fiscal 

agents with information that is 

necessary and/or required in order to 

perform the statutory functions of the 

HQRP; 

3. To provide hospices with 

information they need to meet any 

statutory requirements of the program, 

assist with other reports as required by 

CMS, and to assist in the 

implementation of quality standards; 

4. To support an individual or 

organization for research, as well as 

evaluation or epidemiological projects 

related to end of life care, or for 

understanding and improving payment 

projects; 

5. To support Quality Improvement 

Organizations (QIOs) in connection with 

review of claims, or in connection with 

studies or other review activities 

conducted pursuant to Part B of Title XI 

of the Act, and in performing affirmative 

outreach activities to individuals for the 

purpose of establishing and maintaining 

their entitlement to Medicare benefits or 

health insurance plans; 

6. To assist national accrediting 

organization(s) whose accredited 

providers are presumed to meet certain 

Medicare requirements (e.g., the Joint 

Commission for the Accreditation of 

Healthcare Organizations, the 

Community Health Accreditation 

Program (CHAP), or the Accreditation 

Commission for Health Care (ACHC); 

7. To provide information to the U.S. 

Department of Justice (DOJ), a court, or 

an adjudicatory body when (a) the 

Agency or any component thereof, or (b) 

any employee of the Agency in his or 

her official capacity, or (c) any 

employee of the Agency in his or her 

individual capacity where the DOJ has 

agreed to represent the employee, or (d) 

the United State Government, is a party 

to litigation or has an interest in such 

litigation, and by careful review, CMS 

determines that the records are both 

relevant and necessary to the litigation 

and that the use of such records by the 

DOJ, court, or adjudicatory body is 

compatible with the purpose for which 

the agency collected the records; 

8. To assist a CMS contractor 

(including, but not limited to Medicare 

Administrative Contractors, fiscal 

intermediaries, and carriers) that assists 

in the administration of a CMSadministered health benefits program, 

or to a grantee of a CMS-administered 

grant program, when disclosure is 

deemed reasonably necessary by CMS to 

prevent, deter, discover, detect, 

investigate, examine, prosecute, sue 

with respect to, defend against, correct, 

remedy, or otherwise combat fraud, 

waste or abuse in such program; 

9. To assist another Federal agency or 

to an instrumentality of any 

governmental jurisdiction within or 

under the control of the United States 

(including any state or local 

governmental agency), that administers 

or that has the authority to investigate 

potential fraud, waste or abuse in a 

health benefits program funded in 

whole or in part by Federal funds, when 

disclosure is deemed reasonably 

necessary by CMS to prevent, deter, 

discover, detect, investigate, examine, 

prosecute, sue with respect to, defend 

against, correct, remedy, or otherwise 

combat fraud, waste or abuse in such 

programs; 

10. To disclose records to appropriate 

Federal agencies and Department 

contractors that have a need to know the 

information for the purpose of assisting 

the Department’s efforts to respond to a 

suspected or confirmed breach of the 

security or confidentiality of 

information maintained in this system 

of records, and the information 

disclosed is relevant and necessary for 

that assistance; and 

11. To assist the U.S. Department of 

Homeland Security (DHS) cyber security 

personnel, if captured in an intrusion 

detection system used by HHS and DHS 

(e.g., pursuant to the Einstein 2 

program). 

B. ADDITIONAL CIRCUMSTANCES AFFECTING

DISCLOSURE OF PII DATA: 

To the extent that the individual 

claims records in this system contain 

Protected Health Information (PHI) as 

defined by HHS regulation ‘‘Standards 

for Privacy of Individually Identifiable 

Health Information’’ (45 CFR Parts 160 

and 164, Subparts A and E), disclosures 

of such PHI that are otherwise 

authorized by these routine uses may 

only be made if, and as, permitted or 

required by the ‘‘Standards for Privacy 

of Individually Identifiable Health 

Information’’ (see 45 CFR 164– 

512(a)(1)). 

In addition, HHS policy will be to 

prohibit release even of data not directly 

identifiable with a particular individual, 

except pursuant to one of the routine 

uses or if required by law, if CMS 

determines there is a possibility that a 

particular individual can be identified 

through implicit deduction based on 

small cell sizes (instances where the 

patient population is so small that 

individuals could, because of the small 

size, use this information to deduce the 

identity of a particular individual). 

POLICIES AND PRACTICES FOR STORING, 

RETRIEVING, ACCESSING, RETAINING, AND

DISPOSING OF RECORDS IN THE SYSTEM: 

STORAGE: 

All records are stored on magnetic 

media. 

RETRIEVABILITY: 

Information may be retrieved by any 

of these personal identifiers: provider’s 

TIN (which could be a SSN); NPI; CMS 

Certification Number (CCN); Patient’s 

SSN or a Beneficiary’s HICN; a patient’s 

or beneficiary’s name in combination 

with the patient’s or beneficiary’s date 

of birth. 

SAFEGUARDS: 

Personnel having access to the system 

have been trained in the Privacy Act 

and information security requirements. 

Employees who maintain records in this 

system are instructed not to release data 

until the intended recipient agrees to 

implement appropriate management, 

operational and technical safeguards 

sufficient to protect the confidentiality, 

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19344 Federal Register / Vol. 79, No. 67 / Tuesday, April 8, 2014 / Notices 

integrity and availability of the 

information and information systems 

and to prevent unauthorized access. 

Access to records in the hospice 

database system will be limited to CMS 

personnel and contractors through 

password security, encryption, 

firewalls, and secured operating system. 

Any electronic or hard copies of 

financial-related records containing PII 

at CMS and contractor locations will be 

kept in secure electronic files or in file 

folders locked in secure file cabinets 

during non-duty hours. 

RETENTION AND DISPOSAL: 

Retention and disposal of these 

records are in accordance with 

published record schedules of the 

Centers for Medicare & Medicaid 

Services and as approved by the 

National Archives and Records 

Administration. Beneficiary claims 

records are currently subject to a 

document preservation order and will 

be preserved indefinitely pending 

further notice from the U.S. Department 

of Justice. 

SYSTEM MANAGER AND ADDRESS: 

Director, Division of Chronic & PostAcute Care, Quality Measurement & 

Health Assessment Group, Center for 

Clinical Standards and Quality, Centers 

for Medicare & Medicaid Services, 7500 

Security Boulevard, Mail Stop S3–02– 

01, Baltimore, MD 21244–1850. 

NOTIFICATION PROCEDURE: 

An individual record subject who 

wishes to know if this system contains 

records about him or her should write 

to the system manager who will require 

the system name, HICN, and for 

verification purposes, the subject 

individual’s name (woman’s maiden 

name, if applicable), and SSN. 

Furnishing the SSN is voluntary, but it 

may make searching for a record easier 

and prevent delay. 

RECORD ACCESS PROCEDURE: 

An individual seeking access to 

records about him or her in this system 

should use the same procedures 

outlined in Notification Procedures 

above. The requestor should also 

reasonably specify the record contents 

being sought. (These procedures are in 

accordance with Department regulation 

45 CFR 5b.5(a)(2).) 

CONTESTING RECORD PROCEDURES: 

To contest a record, the subject 

individual should contact the system 

manager named above, and reasonably 

identify the record and specify the 

information to be contested. The 

individual should state the corrective 

action sought and the reasons for the 

correction with supporting justification. 

(These procedures are in accordance 

with Department regulation 45 CFR 

5b.7) 

RECORD SOURCE CATEGORIES: 

Information about individuals 

collected and maintained in this 

database is collected by means of the 

HIS. Hospices may transmit HIS data to 

CMS using free software that is 

provided by CMS. In the alternative, 

hospice providers may submit HIS data 

via customized computer programs 

which are created by private vendors in 

accordance with technical data 

specifications issued by CMS. 

Information transmitted about hospice 

patients is collected by hospice 

providers directly from the patients or 

from the patients’ medical records. Any 

information about an individual 

provider or contact person for a 

provider that is included as the 

provider’s business-identifying 

information on the collection 

instrument is provided by the provider 

or contact person. 

EXEMPTIONS CLAIMED FOR THIS SYSTEM: 

None. 

Dated: March 26, 2014. 

Timothy P. Love, 

Chief Operating Officer, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2014–07552 Filed 4–7–14; 8:45 am] 

BILLING CODE 4120–03–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Comment Request 

Proposed Projects 

Title: Income Withholding for 

Support Order (IWO). 

OMB No.: 0970–0154. 

Description: All individuals and 

entities must use a standard form the 

Secretary of HHS developed to notify 

employers to withhold child support for 

all IV–D and non-IV–D orders. This 

clearance is for one-time changes to the 

IWO form by state child support 

agencies and entities that do not have 

child support automated systems. 

The Office of Child Support 

Enforcement (OCSE) requires child 

support automated systems to be able to 

automatically generate and download 

data to the Office of Management and 

Budget (OMB) approved IWO form. The 

collection of information required by 

state child support agencies and courts 

to populate IWOs in automated systems 

is contained in OMB #0970–0417 and is 

not addressed in this clearance. If the 

state child support agency established 

the child support orders, necessary 

information is already contained in the 

automated system for populating 

income withholding orders. If a court or 

other tribunal issued a child support 

order, then IV–D agency staff enter the 

terms of the order into the automated 

system to issue IWOs. Copies of the 

IWO are made for all necessary parties 

and state child support agencies 

transmit IWOs to the employer/income 

withholder by mail or through the OCSE 

electronic income withholding order (eIWO) portal. Employers are required to 

inform state child support agencies 

when employees with child support 

IWOs terminate their employment; 

notification occurs by sending the IWO 

form or by the e-IWO process. Employer 

responses to IWOs are covered by this 

clearance. 

Custodial parties (CPs) may send the 

IWO form to an employer directly or 

may engage an attorney or private 

collection agency to do so on their 

behalf. This clearance addresses 

custodial parties as they do not have 

access to automated systems for non-IV– 

D orders. 

The IWO form and instructions were 

updated for consistency and clarity in 

light of numerous comments suggesting 

changes received during the 60-day 

comment period of the 1st Federal 

Register Notice publication. 

The information collection is 

authorized by 42 U.S.C. 666(a)(8)(B)(iii) 

and (b)(6)(A)(ii) which requires the use 

of a standard format for income 

withholding. 

Respondents: Employers, non-IV–D 

custodial parties, and e-IWO employers. 

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