Federal Register / Vol. 80, No. 39 / Friday, February 27, 2015 / Notices 10687 

minimize the information collection 

burden. 

DATES: Comments must be received by 

April 28, 2015. 

ADDRESSES: When commenting, please 

reference the document identifier or 

OMB control number. To be assured 

consideration, comments and 

recommendations must be submitted in 

any one of the following ways: 

1. Electronically. You may send 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) that are 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/OMB 

Control Number ____, Room C4–26–05, 

7500 Security Boulevard, Baltimore, 

Maryland 21244–1850. 

To obtain copies of a supporting 

statement and any related forms for the 

proposed collection(s) summarized in 

this notice, you may make your request 

using one of following: 

1. Access CMS’ Web site address at 

http://www.cms.hhs.gov/

PaperworkReductionActof1995. 

2. Email your request, including your 

address, phone number, OMB number, 

and CMS document identifier, to 

Paperwork@cms.hhs.gov. 

3. Call the Reports Clearance Office at 

(410) 786–1326. 

FOR FURTHER INFORMATION CONTACT: 

Reports Clearance Office at (410) 786– 

1326. 

SUPPLEMENTARY INFORMATION: 

Contents 

This notice sets out a summary of the 

use and burden associated with the 

following information collections. More 

detailed information can be found in 

each collection’s supporting statement 

and associated materials (see 

ADDRESSES). 

CMS–1696 Appointment of 

Representative 

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. 

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 

requires federal agencies to publish a 

60-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. 

Information Collection 

1. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Appointment of 

Representative; Use: The Appointment 

of Representative form is completed by 

beneficiaries, providers and suppliers, 

and any party seeking to appoint a 

representative to assist them with their 

initial determinations and filing 

appeals. This extension request 

proposes non-substantive changes to the 

form. Form Number: CMS–1696 (OMB 

control number 0938–0950); Frequency: 

Once; Affected Public: Individuals and 

households and the Private sector 

(Business or other for-profits); Number 

of Respondents: 4,073,960; Total 

Annual Responses: 407,396; Total 

Annual Hours: 101,849. (For policy 

questions regarding this collection 

contact Katherine Hosna at 410–786– 

4993). 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Medicare Feefor-Service Prepayment Medical 

Review; Use: The information required 

under this collection is requested by 

Medicare contractors to determine 

proper payment or if there is a suspicion 

of fraud. Medicare contractors request 

the information from providers or 

suppliers submitting claims for payment 

from the Medicare program when data 

analysis indicates aberrant billing 

patterns or other information which 

may present a vulnerability to the 

Medicare program. Form Number: 

CMS–10417 (OMB control number: 

0938–0969); Frequency: Occasionally; 

Affected Public: Private Sector (Business 

or other for-profit and Not-for-profit 

institutions); Number of Respondents: 

3,211,800; Total Annual Responses: 

3,211,800; Total Annual Hours: 

1,597,950. (For policy questions 

regarding this collection contact Debbie 

Skinner at 410–786–7480.) 

Dated: February 24, 2015. 

William N. Parham, III 

Director, Paperwork Reduction Staff, Office 

of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2015–04115 Filed 2–26–15; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–10341 and CMS– 

10522] 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

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 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. 

DATES: Comments on the collection(s) of 

information must be received by the 

OMB desk officer by March 30, 2015. 

ADDRESSES: When commenting on the 

proposed information collections, 

please reference the document identifier 

or OMB control number. To be assured 

consideration, comments and 

recommendations must be received by 

the OMB desk officer via one of the 

following transmissions: OMB, Office of 

Information and Regulatory Affairs, 

Attention: CMS Desk Officer, Fax 

Number: (202) 395–5806 or Email: 

OIRA_submission@omb.eop.gov. 

To obtain copies of a supporting 

statement and any related forms for the 

mstockstill on DSK4VPTVN1PROD with NOTICES

10688 Federal Register / Vol. 80, No. 39 / Friday, February 27, 2015 / Notices 

proposed collection(s) summarized in 

this notice, you may make your request 

using one of following: 

1. Access CMS’ Web site address at 

http://www.cms.hhs.gov/

PaperworkReductionActof1995. 

2. Email your request, including your 

address, phone number, OMB number, 

and CMS document identifier, to 

Paperwork@cms.hhs.gov. 

3. Call the Reports Clearance Office at 

(410) 786–1326. 

FOR FURTHER INFORMATION CONTACT: 

Reports Clearance Office at (410) 786– 

1326. 

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: Extension of a currently 

approved collection; Title of 

Information Collection: Affordable Care 

Act Information and Collection 

Requirements for Section 1115 

Demonstration Projects; Use: This 

collection is necessary to ensure that 

states comply with regulatory and 

statutory requirements related to the 

development, implementation and 

evaluation of demonstration projects. 

States seeking waiver authority under 

Section 1115 are required to meet 

certain requirements for public notice, 

the evaluation of demonstration 

projects, and reports to the Secretary on 

the implementation of approved 

demonstrations. Form Number: CMS– 

10341 (OMB control number 0938– 

1162); Frequency: Yearly; Affected 

Public: State, Local, or Tribal 

Governments; Number of Respondents: 

37; Total Annual Responses: 130; Total 

Annual Hours: 13,910. (For policy 

questions regarding this collection 

contact Lane Terwilliger at 410–786– 

2059.) 

2. Type of Information Collection 

Request: New collection (Request for a 

new OMB control number); Title of 

Information Collection: Executive 

Summary Form for Research Identifiable 

Data; Use: The Centers for Medicare & 

Medicaid Services (CMS) is responsible 

for administering the Medicare, 

Medicaid and State Children’s Health 

Insurance Programs. We collect data to 

support the Agency’s mission and 

operations. These data include 

information about Medicare 

beneficiaries, Medicare claims, 

Medicare providers, and Medicaid 

eligibility and claims. We disclose the 

identifiable data consistent with the 

routine uses identified in the Privacy 

Act Systems of Records notices that are 

published in the Federal Register and 

the limitations on uses and disclosures 

that are set out in the HIPAA Privacy 

Rule. 

All requests for identifiable data are 

received and reviewed by the Division 

of Privacy Operations & Compliance 

(DPOC) in the Office of E-Health 

Standards and Services. The DPOC staff 

and the CMS Privacy Officer review the 

requests to determine if there is legal 

authorization for disclosure of the data. 

If legal authorization exists, the request 

is reviewed to ensure that the minimal 

data necessary is requested and 

approved for the project. Requests for 

identifiable data for research purposes 

must be submitted to and approved by 

the CMS Privacy Board. To assist the 

CMS Privacy Board with its review of 

research data requests, OIPDA has 

developed the Executive Summary (ES) 

forms. The ES collects all the 

information that the CMS Privacy Board 

needs to review and make a 

determination on whether the request 

meets the requirements for release of 

identifiable data for research purposes. 

We currently have three versions of the 

ES Form and an ES Supplement for 

Requestors of the National Death Index 

(NDI) Causes of Death Variables. Each 

meets the need for a different type of 

requestor. Form Number: CMS–10522 

(OMB control number: 0938–New); 

Frequency: On occasion; Affected 

Public: State, Local, or Tribal 

Governments; Number of Respondents: 

325; Total Annual Responses: 325; Total 

Annual Hours: 650. (For policy 

questions regarding this collection 

contact Kim Elmo at 410–786–0161.) 

Dated: February 24, 2015. 

William N. Parham, III, 

Director, Paperwork Reduction Staff, Office 

of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2015–04113 Filed 2–26–15; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–7036–N] 

Health Insurance Marketplace, 

Medicare, Medicaid, and Children’s 

Health Insurance Programs; Renewal 

of the Advisory Panel on Outreach and 

Education (APOE) and Request for 

Nominations 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice. 

SUMMARY: This notice announces the 

renewal of the Advisory Panel (the 

Panel) on Outreach and Education 

(APOE) charter. It also requests 

nominations for individuals to serve on 

the APOE. 

DATES: Nominations will be considered 

if we receive them at the appropriate 

address, provided in the ADDRESSES

section of this notice, no later than 5 

p.m., Eastern Daylight Time (e.d.t.) on 

March 30, 2015. 

ADDRESSES: Mail nominations to the 

following address: Abigail Huffman, 

Designated Federal Official, Office of 

Communications, CMS, 7500 Security 

Boulevard, Mail Stop S1–13–05, 

Baltimore, MD 21244–1850 or email 

nominations to 

Abigail.Huffman1@cms.hhs.gov. 

FOR FURTHER INFORMATION CONTACT: 

Abigail Huffman, Designated Federal 

Official, Office of Communications, 

CMS, 7500 Security Boulevard, Mail 

Stop S1–13–05, Baltimore, MD 21244, 

410–786–0897, email 

Abigail.Huffman1@cms.hhs.gov or visit 

the Web site at http://www.cms.gov/ 

Regulations-and-Guidance/Guidance/ 

FACA/APOE.html. Press inquiries are 

handled through the CMS Press Office 

at (202) 690–6145. 

SUPPLEMENTARY INFORMATION: 

I. Background 

The Advisory Panel (the Panel) on 

Medicare Education (the predecessor to 

the APOE) was created in 1999 to advise 

and make recommendations to the 

Secretary of the U.S. Department of 

Health and Human Services (HHS), and 

mstockstill on DSK4VPTVN1PROD with NOTICES