### 35444 Federal Register / Vol. 76, No. 117 / Friday, June 17, 2011 / Notices

Mary Forbes, Paperwork Reduction Act Clearance Officer, Office of the Secretary.

[FR Doc. 2011–15079 Filed 6–16–11; 8:45 am]

**BILLING CODE 4150–33–P**

**DEPARTMENT OF HEALTH AND HUMAN SERVICES** 

**[Document Identifier OS–0990–New; 60-Day Notice]** 

**Agency Information Collection Request. 60-Day Public Comment**  **Request**

**AGENCY :**  Office of the Secretary, HHS.

In compliance with the requirement of section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is publishing the following summary of a proposed information collection request 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.

To obtain copies of the supporting statement and any related forms for the proposed paperwork collections referenced above, e-mail your request, including your address, phone number, OMB number, and OS document identifier, to Sherette.funncoleman@hhs.gov, or call the Reports Clearance Office on (202) 690–6162. Written comments and recommendations for the proposed information collections must be directed to the OS Paperwork Clearance Officer at the above e-mail address within 60- days.
Proposed Project: HIV/AIDS Prevention and Support Service for Women Partners of Incarcerated/RecentlyReleased Men—OMB No. 0990–NewOffice of Women’s Health

Abstract: The mission of the Office on Women’s Health (OWH) is to provide leadership to promote health equity for women and girls through sex/genderspecific approaches. To that end, OWH has established public/private partnerships to address critical women’s health issues nationwide including cooperative agreements awarded to eight community-based organizations in 2009 to design and implement innovative and gender responsive HIV prevention programs to meet the unique
risks and needs of women within their communities who have currently incarcerated or recently released male partners (‘‘women partners’’). The information presented in this evaluation study is needed to determine the overarching outcomes of the set of the eight programs. The three-year study will include quantitative data collected at three time points, intervention baseline, post-intervention, and 30 day follow-up. The study will also include qualitative data collected through focus groups facilitated with program participants at each of the eight program sites, as well as interviews with one to two key intervention staff at each of the program sites.



### E STIMATED 

### ANNUALIZED 

### B URDEN 

### TABLE

Forms Type of respondent Number of respondents Number of
responses per

respondent Average burden (in hours)
per response Total burden hours

Baseline Survey ................................ Program Participant ......................... 320 1 15/60 80 Post Intervention Survey ................... Program Participant ......................... 288 1 15/60 72 30 day Follow-up Survey .................. Program Participant ......................... 256 1 15/60 64 Focus Group ..................................... Program Participant ......................... 64 1 1.0 64 Staff Interview ................................... Intervention Staff .............................. 8 1 1.0 8

Total ........................................... ........................................................... ........................ ........................ ........................ 288

Mary Forbes, Paperwork Reduction Act Clearance Officer Office of the Secretary.

[FR Doc. 2011–15077 Filed 6–16–11; 8:45 am]

**BILLING CODE 4150–33–P**

**DEPARTMENT OF HEALTH AND HUMAN SERVICES** 

**Centers for Medicare & Medicaid Services** 

**[Document Identifier CMS–1856 and CMS– 1893]** 

**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: Extension of a currently approved collection; Title of Information Collection: (CMS–1856) Request for Certification in the Medicare and/or Medicaid Program to Provide Outpatient Physical Therapy and/or Speech Pathology Services, and (CMS– 1893) Outpatient Physical Therapy— Speech Pathology Survey Report; Use: CMS–1856 is used as an application to be completed by providers of outpatientphysical therapy and/or speechlanguage pathology services requesting participation in the Medicare and Medicaid programs. This form initiates the process for obtaining a decision as to whether the conditions of participation are met as a provider of outpatient physical therapy and/or


### 35445 Federal Register / Vol. 76, No. 117 / Friday, June 17, 2011 / Notices

speech-language pathology services. It is used by the State agencies to enter new provider into the Automated Survey Process Environment (ASPEN). CMS– 1893 is used by the State survey agencyto record data collected during an onsite survey of a provider of outpatientphysical therapy and/or speechlanguage pathology services, to determine compliance with the applicable conditions of participation, and to report this information to the Federal government. The form is primarily a coding worksheet designed
to facilitate data reduction and retrieval into the ASPEN system. The
information needed to make
certification decisions is available to CMS only through the use of information abstracted from the form;
Form Numbers: CMS–1856 and CMS– 1893 (OMB#: 0938–0065); Frequency: Annually, occasionally; Affected Public:Private Sector; Business or other forprofit and not-for-profit institutions; Number of Respondents: 2,968; Total Annual Responses: 495; Total Annual

Hours: 866. (For policy questions regarding this collection contact Georgia Johnson at 410–786–6859. 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 18, 2011: OMB, Office of Information and Regulatory Affairs,

Attention: CMS Desk Officer, Fax Number: (202) 395–6974, E-mail:
OIRA

_submission@omb.eop.gov.

Dated: June 14, 2011.
Michelle Shortt, Director, Regulations Development Group, Office of Strategic Operations and Regulatory Affairs.

[FR Doc. 2011–15057 Filed 6–16–11; 8:45 am]

**BILLING CODE 4120–01–P DEPARTMENT OF HEALTH AND**  **HUMAN SERVICES**

**Centers for Medicare & Medicaid Services** 

**[Document Identifier CMS–10334 and CMS– 10373]** 

**Agency Information Collection Activities: Proposed Collection;**  **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) 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: Revision of a currently approved collection; Title of Information Collection: Application for Coverage in the Pre-Existing Condition Insurance Plan; Use: The Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services, Center for Consumer Information and Insurance Oversight is requesting clearance by the Office of Management and Budget for modifications to this previously approved collection package. These changes are being requested to (1) provide a mechanism for a PCIPenrollee who has moved from a stateadministered PCIP to quickly andefficiently enroll into the federallyadministered PCIP (2) provide a mechanism for a PCIP applicant to identify a third party entity will pay their premium to ensure appropriate premium billing (3) provide a mechanism whereby a licensed insurance agent or broker may identify their referral of an applicant (4) request employer information to expand ways to identify and prevent instances of insurer dumping and (5) make clarifications to existing application language. Form Number: CMS–10334 (OCN: 0938–1095) Frequency: Once; Affected Public: Individuals or households; Number of Respondents: 83,333; Number of Responses: 83,333; Total Annual Hours: 179,499. (For policy questions regarding this collection, contact Laura Dash at 410–786–8623. For all other issues call (410) 786–1326.)

2. Type of Information Collection Request: Revision of a currently approved collection; Title of Information Collection: Medical Loss Ratio Quarterly Reporting; Use: Under Section 2718 of the Affordable Care Act and implementing regulations at 45 CFR Part 158 (75 FR 74865, December 1, 2010) as modified by technical corrections on December 30, 2010 (75 FR 82277), a health insurance issuer (issuer) offering group or individual health insurance coverage must submit a report to the Secretary concerning the amount the issuer spends each year on claims, quality improvement expenses, non-claims costs, Federal and State taxes and licensing or regulatory fees, and the amount of earned premium. An issuer must provide an annual rebate to enrollees if the amount it spends on certain costs compared to its premium revenue (excluding Federal and States taxes and licensing or regulatory fees) does not meet a certain ratio, referred to as the medical loss ratio (MLR). An interim final rule (IFR) implementing the MLR was published on December 1, 2010 (75 FR 74865) and modified by technical corrections on December 30, 2010 (75 FR 82277), which added Part 158 to Title 45 of the Code of Federal Regulations. The IFR is effective January 1, 2011. Issuers are required to submit annual MLR reporting data for each large group market, small group market, and individual market within each State in which the issuer conducts business. For policies that have a total annual limit of $250,000 or less (sometimes referred to as ‘‘mini-med plans’’) and for group policies that primarily cover employees working outside the United States (referred to as ‘‘expatriate plans’’), the IFR applies a special circumstance adjustment to the MLR data for the 2011 MLR reporting year. In order to evaluate the appropriateness of this special circumstance adjustment for years 2012 and beyond, issuers that provide such policies are required to submit quarterly MLR data to the Secretary for the 2011 MLR reporting year. We received several comments in response to the emergency 30-day comment period that was associated with CMS–10373. We have taken into consideration all of the revisions that were proposed and have amended the quarterly reporting form to include issuer contact information and