18916 Federal Register / Vol. 79, No. 65 / Friday, April 4, 2014 / Notices 

approved collection; Title of 

Information Collection: Disclosure for 

the In-Office Ancillary Services 

Exception; Use: Physicians who provide 

certain imaging services (magnetic 

resonance imaging, computed 

tomography, and positron emission 

tomography) under the in-office 

ancillary services exception to the 

physician self-referral prohibition are 

required to create the disclosure notice 

as well as the list of other imaging 

suppliers to be provided to the patient. 

The patient will then be able to use the 

disclosure notice and list of suppliers in 

making an informed decision about his 

or her course of care for the imaging 

service. The physician must maintain a 

record of the disclosure in the patient’s 

medical record. If we were investigating 

the referrals of a physician providing 

advanced imaging services under the inoffice ancillary services exception, we 

would review the written disclosure in 

order to determine if the physician 

satisfied the requirement. Form 

Number: CMS–10332 (OCN: 0938– 

1133); Frequency: Occasionally; 

Affected Public: Private sector— 

Business or other for-profits; Number of 

Respondents: 71,000; Total Annual 

Responses: 71,106; Total Annual Hours: 

125,383. (For policy questions regarding 

this collection contact Jacqueline 

Proctor at 410–786–8852). 

Dated: April 1, 2014. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2014–07575 Filed 4–3–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers: CMS–437 and CMS– 

10332] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, HHS. 

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 (the 

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 

60 days for public comment on the 

proposed action. Interested persons are 

invited to send comments regarding our 

burden estimates 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 must be received by 

June 3, 2014. 

ADDRESSES: When commenting, please 

reference the document identifier or 

OMB control number (OCN). 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 llll 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–437 Psychiatric Unit Criteria 

Work Sheet and Supporting 

Regulations 

CMS–10332 Disclosure for the InOffice Ancillary Services Exception 

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: Reinstatement with Change of 

a currently approved collection; Title of 

Information Collection: Psychiatric Unit 

Criteria Work Sheet and Supporting 

Regulations; Use: Certain hospital units 

are excluded from the Medicare 

Prospective Payment System (PPS). The 

exclusion of units is not optional on the 

part of the provider but is required by 

section 1886(d)(1)(B) of the Social 

Security Act. That section excludes 

psychiatric hospitals, rehabilitation 

hospitals, hospitals whose inpatients are 

predominantly individuals under 18 

years of age (children’s hospitals), and 

psychiatric and rehabilitation units 

which are a distinct part of a hospital. 

We propose to continue the current 

process of performing initial 

verifications and annual reverifications 

to determine that psychiatric units 

continue to comply with the regulatory 

criteria at 42 CFR 412.25 and 42 CFR 

412.27 of the PPS regulations. These 

regulations state the criteria that distinct 

part units must meet for exclusion. 

If, as a result of the regular survey 

process a hospital is certified as a 

psychiatric hospital by the State survey 

agency (SA), then it automatically 

satisfies the regulatory criteria for 

exclusion. Thus, no additional 

mstockstill on DSK4VPTVN1PROD with NOTICES

Federal Register / Vol. 79, No. 65 / Friday, April 4, 2014 / Notices 18917 

verification is required for psychiatric 

hospitals. Some verification is needed, 

however, to ensure that other types of 

hospitals and units meet the criteria for 

exclusion. Consequently, we instructed 

the Fiscal Intermediaries (FIs) and SAs 

to perform certain verification activities, 

beginning in October 1983 when PPS 

was implemented. We originally 

developed the CMS–437 as an SA 

Worksheet for verifying exclusions from 

PPS for psychiatric units. 

Since April 9, 1994, PPS-excluded 

psychiatric units already excluded from 

the PPS have met CMS’s annual 

requirement for PPS-exclusion by selfattesting that they remain in compliance 

with the PPS exclusion criteria. Under 

the current procedure, all psychiatric 

units applying for first-time exclusion 

are surveyed by the SAs. The SAs also 

perform surveys to investigate 

complaint allegations and conduct 

annual sample reverification surveys on 

5 percent of all psychiatric units. The 

aforementioned exclusions continue to 

exist and thus we propose to continue 

to use the Criteria Worksheet, Forms 

CMS–437, for verifying first-time 

exclusions from the PPS, for complaint 

surveys, for its annual 5 percent 

validation sample, and for facility selfattestation. These forms are related to 

the survey and certification and 

Medicare approval of the PPS-excluded 

units. Form Number: CMS–437 (OCN: 

0938–0358); Frequency: Annually; 

Affected Public: Private sector— 

Business or other for-profits; Number of 

Respondents: 1,614; Total Annual 

Responses: 1,614; Total Annual Hours: 

404. (For policy questions regarding this 

collection contact Donald Howard at 

410–786–6764.) 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Disclosure for 

the In-Office Ancillary Services 

Exception; Use: Physicians who provide 

certain imaging services (magnetic 

resonance imaging, computed 

tomography, and positron emission 

tomography) under the in-office 

ancillary services exception to the 

physician self-referral prohibition are 

required to create the disclosure notice 

as well as the list of other imaging 

suppliers to be provided to the patient. 

The patient will then be able to use the 

disclosure notice and list of suppliers in 

making an informed decision about his 

or her course of care for the imaging 

service. The physician must maintain a 

record of the disclosure in the patient’s 

medical record. If we were investigating 

the referrals of a physician providing 

advanced imaging services under the inoffice ancillary services exception, we 

would review the written disclosure in 

order to determine if the physician 

satisfied the requirement. Form 

Number: CMS–10332 (OCN: 0938– 

1133); Frequency: Occasionally; 

Affected Public: Private sector— 

Business or other for-profits; Number of 

Respondents: 71,000; Total Annual 

Responses: 71,106; Total Annual Hours: 

125,383. (For policy questions regarding 

this collection contact Jacqueline 

Proctor at 410–786–8852). 

Dated: April 1, 2014. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2014–07582 Filed 4–3–14; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Comment Request Proposed 

Projects 

Title: Family Violence Prevention and 

Services: Grants to States; Native 

American Tribes and Alaskan Native 

Villages; and State Domestic Violence 

Coalitions 

OMB No.: 0970–0280 

Description: The Family Violence 

Prevention and Services Act (FVPSA), 

42 U.S.C. 10401 et seq., authorizes the 

Department of Health and Human 

Services to award grants to States, 

Tribes—and Tribal Organizations, and 

State Domestic Violence Coalitions for 

family violence prevention and 

intervention activities. The proposed 

information collection activities will be 

used to make grant award decisions and 

to monitor grant performance. 

Respondents: State Agencies 

Administering FVPSA Grants; Tribal 

Governments and Tribal Organizations; 

and State Domestic Violence Coalitions. 

ANNUAL BURDEN ESTIMATES

Instrument Number of 

respondents 

Number of 

responses per 

respondent 

Average 

burden hours 

per response 

Total burden 

hours 

State Grant Application .................................................................................... 53 1 10 530 

Tribal Grant Application ................................................................................... 150 1 5 750 

State Domestic Violence Coalition Application ................................................ 56 1 10 560 

State FVPSA Grant Performance Progress Report ........................................ 53 1 10 530 

Tribal FVPSA Grant Performance Progress Report ........................................ 150 1 10 1,500 

State Domestic Violence Coalition Performance Progress Report ................. 56 1 10 560 

Estimated Total Annual Burden Hours ..................................................... ........................ ........................ ........................ 4,430 

In compliance with the requirements 

of Section 506(c)(2)(A) of the Paperwork 

Reduction Act of 1995, the 

Administration for Children and 

Families is soliciting public comment 

on the specific aspects of the 

information collection described above. 

Copies of the proposed collection of 

information can be obtained and 

comments may be forwarded by writing 

to the Administration for Children and 

Families, Office of Planning, Research 

and Evaluation, 370 L’Enfant 

Promenade SW., Washington, DC 20447, 

Attn: ACF Reports Clearance Officer. 

Email address: infocollection@

acf.hhs.gov. All requests should be 

identified by the title of the information 

collection. 

The Department specifically requests 

comments on: (a) Whether the proposed 

collection of information is necessary 

for the proper performance of the 

functions of the agency, including 

whether the information shall have 

practical utility; (b) the accuracy of the 

agency’s estimate of the burden of the 

proposed collection of information; (c) 

the quality, utility, and clarity of the 

information to be collected; and (d) 

ways to minimize the burden of the 

collection of information on 

respondents, including through the use 

of automated collection techniques or 

other forms of information technology. 

Consideration will be given to 

mstockstill on DSK4VPTVN1PROD with NOTICES