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/Recently 

Released 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. 

ESTIMATED ANNUALIZED BURDEN 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 outpatient 

physical 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 


emcdonald on DSK2BSOYB1PROD with NOTICES
Federal Register / Vol. 76, No. 117 / Friday, June 17, 2011 / Notices 35445 

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 agency 

to record data collected during an onsite survey of a provider of outpatient 

physical 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 PCIP 

enrollee who has moved from a stateadministered PCIP to quickly and 

efficiently 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 


emcdonald on DSK2BSOYB1PROD with NOTICES