Federal Register / Vol. 75, No. 136 / Friday, July 16, 2010 / Notices 41487 

respond, through the use of appropriate 

technological collection techniques or 

other forms of information technology. 

DATES: Submit comments on or before 

September 14, 2010. 

ADDRESSES: Submit comments 

identified by Information Collection 

9000–0012 by any of the following 

methods: 

• Regulations.gov: http:// 

www.regulations.gov. Submit comments 

via the Federal eRulemaking portal by 

inputting ‘‘Information Collection 9000– 

0012’’ under the heading ‘‘Enter 

Keyword or ID’’ and selecting ‘‘Search’’. 

Select the link ‘‘Submit a Comment’’ that 

corresponds with ‘‘Information 

Collection 9000–0012’’. Follow the 

instructions provided at the ‘‘Submit a 

Comment’’ screen. Please include your 

name, company name (if any), and 

‘‘Information Collection 9000–0012’’ on 

your attached document. 

• Fax: (202) 501–4067. 

• Mail: General Services 

Administration, Regulatory Secretariat 

(MVCB), 1800 F Street, NW., Room 

4041, Washington, DC 20405. ATTN: 

Hada Flowers/IC 9000–0012. 

Instructions: Please submit comments 

only and cite Information Collection 

9000–0012, in all correspondence 

related to this collection. All comments 

received will be posted without change 

to http://www.regulations.gov, including 

any personal and/or business 

confidential information provided. 

SUPPLEMENTARY INFORMATION: 

A. Purpose 

The termination settlement proposal 

forms (Standard Forms 1435 through 

1440) provide a standardized format for 

listing essential cost and inventory 

information needed to support the 

terminated contractor’s negotiation 

position. Submission of the information 

assures that a contractor will be fairly 

reimbursed upon settlement of the 

terminated contract. 

B. Annual Reporting Burden 

Respondents: 872. 

Responses per Respondent: 2.4. 

Total Responses: 2,092. 

Hours per Response: 2.4. 

Total Burden Hours: 5,023. 

Obtaining Copies of Proposals: 

Requester may obtain a copy of the 

proposal from the General Services 

Administration, Regulatory Secretariat 

(MVCB), 1800 F Street, NW., Room 

4041, Washington, DC 20405, telephone 

(202) 501–4755. Please cite OMB 

Control No. 9000–0012, Termination 

Settlement Proposal Forms—FAR (SF’s 

1435 through 1440), in all 

correspondence. 

Dated: July 12, 2010. 

Edward Loeb, 

Director, Acquisition Policy Division. 

[FR Doc. 2010–17366 Filed 7–15–10; 8:45 am] 

BILLING CODE 6820–34–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–10165, CMS– 

10003 and CMS–901A and 901D] 

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: Revision of a currently 

approved collection; Title of 

Information Collection: Electronic 

Health Records Demonstration System 

(EHRDS)—practice application and 

profile update system; Use: In 2008, the 

Secretary of the Department of Health 

and Human Services directed the 

Centers for Medicare & Medicaid 

Services to develop a new 

demonstration initiative using Medicare 

waiver authority to reward the delivery 

of high-quality care supported by the 

adoption and use of electronic health 

records (EHRs). This continues to be a 

critical priority under the current 

administration. The goal of this 

demonstration is to foster the 

implementation and adoption of EHRs 

and health information technology (HIT) 

more broadly as effective vehicles to 

improve the quality of care provided 

and transform the way medicine is 

practiced and delivered. Adoption of 

HIT has the potential to provide 

significant savings to the Medicare 

program and improve the quality of care 

rendered to Medicare beneficiaries. 

The new electronic EHR 

demonstration system was first 

developed with the intention of having 

practices applying to participate in 

Phase 2 of the demonstration use an online application form, rather than the 

currently approved paper application 

form that was used for Phase 1. 

However, with the cancellation of Phase 

2, the system will not be used to collect 

new applications at this time. Instead, 

existing data on Phase 1 applications 

that was collected through the paper 

form and manually keyed into a PC 

based Access database will be 

transferred to the new system. Practices 

participating in Phase 1 of the 

demonstration will be requested to use 

the new system to provide periodic 

updates to their practice information. 

The EHR Demonstration system will 

enable practices to update critical 

demonstration information online in a 

secure, web-enabled environment, 

thereby facilitating timely and more 

accurate updates and processing of 

information. Thus, the EHR 

Demonstration system (EHRDS) does 

not reflect a request for new or 

additional data beyond what practices 

are already providing to CMS and its 

contractors. Rather it represents an 

effort to streamline and improve what 

has been a more ‘ad hoc’ process for 

providing the same information. Form 

Number: CMS–10165 (OMB#: 0938– 

0965); Frequency: Occasionally; 

Affected Public: Business or other forprofits and Not-for-profit institutions; 

Number of Respondents: 400; Total 

Annual Responses: 313; Total Annual 

Hours: 52.3. (For policy questions 

regarding this collection contact Jody 

Blatt at 410–786–6921. For all other 

issues call 410–786–1326.) 

2. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Notice of Denial 

of Medical Coverage (NDMC) and Notice 

of Denial of Payment (NDP)—42 CFR 

422.568; Use: Medicare health plans, 

including Medicare Advantage plans, 

cost plans, and Health Care Prepayment 

Plans (HCPPs), are required to issue the 

NDMC and NDP when a request for 

either a medical service or payment is 

denied in whole or in part. 

Additionally, the notices inform 

Medicare enrollees of their right to file 

an appeal. All Medicare health plans are 

required to use these standardized 

notices. Medicare health plans provide 


srobinson on DSKHWCL6B1PROD with NOTICES
41488 Federal Register / Vol. 75, No. 136 / Friday, July 16, 2010 / Notices 

an NDMC to enrollees upon denial, in 

whole or in part, of an enrollee’s 

coverage request. This denial may be 

subject to a series of administrative 

review levels, involving defined steps 

and timeframes. The NDMC was 

developed to ensure Medicare enrollees 

have access to information needed to 

navigate the Medicare beneficiary 

appeals process. The NDMC meets 

requirements for both Medicare’s 

standard and expedited appeals 

processes. 

Medicare health plans provide an 

NDP to enrollees upon denial, in whole 

or in part, of payment for a service or 

item that the enrollee received. This 

denial may be subject to a series of 

administrative review levels, involving 

defined steps and timeframes. The NDP 

was developed to ensure Medicare 

enrollees have access to information 

needed to navigate the Medicare 

beneficiary appeals process. The NDP 

meets requirements for Medicare’s 

standard appeals process. Form 

Number: CMS–10003 (OMB#: 0938– 

0829); Frequency: Yearly; Affected 

Public: Business or other for-profits and 

Not-for-profit institutions; Number of 

Respondents: 740; Total Annual 

Responses: 1,168,368; Total Annual 

Hours: 194,728. (For policy questions 

regarding this collection contact 

Stephanie Simons at 206–615–2420. For 

all other issues call 410–786–1326.) 

3. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Federal 

Qualification Application (42 CFR 

417.140) and Medicare Health Care 

Prepayment Plan Application (42 CFR 

417.800); Use: The application is the 

collection form used to obtain 

information to determine if an applicant 

meets the regulatory requirements to 

enter into a contract with CMS as a 

Federal Qualified health maintenance 

organization (HMO) or to provide health 

benefits to Medicare beneficiaries as a 

Medicare Health Care Prepayment Plan 

contractor. Form Number: CMS–901A & 

901D (OMB#: 0938–0470); Frequency: 

Once; Affected Public: Business or other 

for-profits and Not-for-profit 

institutions; Number of Respondents: 

20; Total Annual Responses: 20; Total 

Annual Hours: 800. (For policy 

questions regarding this collection 

contact Heidi Arndt at 410–786–1607. 

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 August 16, 2010. 

OMB, Office of Information and 

Regulatory Affairs, Attention: CMS 

Desk Officer, Fax Number: (202) 395– 

6974, E-mail: OIRA_submission 

@omb.eop.gov. 

Dated: July 9, 2010. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2010–17181 Filed 7–15–10; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Substance Abuse and Mental Health 

Services Administration 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

Periodically, the Substance Abuse and 

Mental Health Services Administration 

(SAMHSA) will publish a summary of 

information collection requests under 

OMB review, in compliance with the 

Paperwork Reduction Act (44 U.S.C. 

Chapter 35). To request a copy of these 

documents, call the SAMHSA Reports 

Clearance Officer on (240) 276–1243. 

Project: Mandatory Guidelines for 

Federal Workplace Drug Testing 

Programs (OMB No. 0930–0158)— 

Revision 

SAMHSA’s Mandatory Guidelines for 

Federal Workplace Drug Testing 

Programs will request OMB approval for 

the Federal Drug Testing Custody and 

Control Form for Federal agency and 

federally regulated drug testing 

programs which must comply with the 

HHS Mandatory Guidelines for Federal 

Workplace Drug Testing Programs (73 

FR 71858) dated November 25, 2008, 

and for the information provided by 

laboratories for the National Laboratory 

Certification Program (NLCP). 

The Federal Drug Testing Custody 

and Control Form (Federal CCF) is used 

by all Federal agencies and employers 

regulated by the Department of 

Transportation to document the 

collection and chain of custody of urine 

specimens at the collection site, for 

laboratories to report results, and for 

Medical Review Officers to make a 

determination. The current Federal CCF 

approved by OMB has a November 30, 

2011 expiration date. SAMHSA has 

resubmitted the Federal CCF with 

revisions to the form for OMB approval. 

• The first change is to add a new 

item in Step 1 of Copy 1, which lists the 

acronyms for the Federal testing 

authorities under which the specimen is 

collected. The new Step 1 (d) would 

read as follows: ‘‘D. Specify Testing 

Authority: HHS, NRC, DOT—Specify 

DOT Agency: FMCSA, FAA, FRA, FTA, 

PHMSA, USCG’’ with a checkbox beside 

each agency name. 

• The second change is to revise the 

Federal CCF Copy 1 to permit use by 

Instrumented Initial Test Facility (IITF), 

in addition to laboratories. 

• The third change is to add the new 

drug analytes required by the revised 

Guidelines to the Primary Specimen 

Report section in Step 5(a) on Copy 1. 

The new drug analytes are 

methylenedioxymethamphetamine 

(MDMA), commonly known as 

‘‘ecstasy’’; methyleneamphetamine 

(MDA), and 

methylenedioxyethylamphetamine 

(MDEA). MDA and MDEA are both close 

chemical analogues of MDMA. 

• The fourth change is to revise the 

Medical Review Officer (MRO) reporting 

sections on Copy 2 for primary 

specimens (Step 6) and for split 

specimens (Step 7) to facilitate reporting 

in accordance with the Guidelines. 

Below is a copy of the revised Federal 

CCF: 

BILLING CODE 4162–20–P 


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