35218 Federal Register / Vol. 87, No. 111 / Thursday, June 9, 2022 / Notices 

Hours: 29,935,899. (For policy questions 

regarding this collection contact Diane 

Corning at 410–786–8486.) 

3. Type of Information Collection 

Request: Reinstatement without change 

of a previously approved collection; 

Title of Information Collection: 

Medicare Authorization to Disclose 

Personal Health Information; Use: The 

‘‘Medicare Authorization to Disclose 

Personal Health Information’’ will be 

used by Medicare beneficiaries to 

authorize Medicare to disclose their 

protected health information to a third 

party. Medicare beneficiaries can submit 

the Medicare Authorization to Disclose 

Personal Health Information 

electronically at Medicare.gov. 

Beneficiaries may also submit the 

Medicare Authorization to Disclose 

Personal Health Information by mailing 

a complete and valid authorization form 

to Medicare. Beneficiaries can submit 

the Medicare Authorization to Disclose 

Personal Health Information verbally 

over the phone by calling Medicare. 

Form Number: CMS–10106 (OMB 

control number: 0938–0930); Frequency: 

Occasionally; Affected Public: 

Individuals or households; Number of 

Respondents: 1,000,000; Total Annual 

Responses: 1,000,000; Total Annual 

Hours: 250,000. (For policy questions 

regarding this collection contact Sam 

Jenkins at 410–786–3261.) 

Dated: June 3, 2022. 

William N. Parham, III, 

Director, Paperwork Reduction Staff, Office 

of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2022–12378 Filed 6–8–22; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers CMS–R–284] 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, Health and Human 

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 

(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 the necessity and 

utility of the proposed information 

collection for the proper performance of 

the agency’s functions, the accuracy of 

the estimated burden, ways to enhance 

the quality, utility, and clarity of the 

information to be collected, and 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 July 11, 2022. 

ADDRESSES: Written comments and 

recommendations for the proposed 

information collection should be sent 

within 30 days of publication of this 

notice to www.reginfo.gov/public/do/ 

PRAMain. Find this particular 

information collection by selecting 

‘‘Currently under 30-day Review—Open 

for Public Comments’’ or by using the 

search function. 

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’ website address at 

website address at: https://

www.cms.gov/Regulations-andGuidance/Legislation/Paperwork

ReductionActof1995/PRA-Listing. 

FOR FURTHER INFORMATION CONTACT: 

William Parham at (410) 786–4669. 

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: Revision of a currently 

approved collection; Title of 

Information Collection: Transformed— 

Medicaid Statistical Information System 

(T–MSIS); Use: The data reported in T– 

MSIS are used by federal, state, and 

local officials, as well as by private 

researchers and corporations to monitor 

past and projected future trends in the 

Medicaid program. The data provide the 

only national level information 

available on enrollees, beneficiaries, and 

expenditures. It also provides the only 

national level information available on 

Medicaid utilization. The information is 

the basis for analyses and for cost 

savings estimates for the Department’s 

cost sharing legislative initiatives to 

Congress. The collected data are also 

crucial to our actuarial forecasts. Form 

Number: CMS–R–284 (OMB control 

number: 0938–0345); Frequency: 

Quarterly and monthly; Affected Public: 

State, Local, or Tribal Governments; 

Number of Respondents: 54; Total 

Annual Responses: 684; Total Annual 

Hours: 6,480. (For policy questions 

regarding this collection contact Connie 

Gibson at 410–786–0755.) 

Dated: June 3, 2022. 

William N. Parham, III, 

Director, Paperwork Reduction Staff, Office 

of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2022–12386 Filed 6–8–22; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers: CMS–10328] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, Health and Human 

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 


lotter on DSK11XQN23PROD with NOTICES1
Federal Register / Vol. 87, No. 111 / Thursday, June 9, 2022 / Notices 35219 

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 

the necessity and utility of the proposed 

information collection for the proper 

performance of the agency’s functions, 

the accuracy of the estimated burden, 

ways to enhance the quality, utility, and 

clarity of the information to be 

collected, and the use of automated 

collection techniques or other forms of 

information technology to minimize the 

information collection burden. 

DATES: Comments must be received by 

August 8, 2022. 

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: lll, 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’ website address at 

website address at https://www.cms.gov/ 

Regulations-and-Guidance/Legislation/ 

PaperworkReductionActof1995/PRAListing. 

FOR FURTHER INFORMATION CONTACT: 

William N. Parham at (410) 786–4669. 

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–10328—Medicare Self-Referral 

Disclosure Protocol 

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: Revision of a currently 

approved collection; Title of 

Information Collection: Medicare SelfReferral Disclosure Protocol; Use: 

Section 6409 of the ACA requires the 

Secretary to establish a voluntary selfdisclosure process that allows providers 

of services and suppliers to self-disclose 

actual or potential violations of section 

1877 of the Act. The SRDP is a 

voluntary self-disclosure process that 

allows providers of services and 

suppliers to disclose actual or potential 

violations of section 1877 of the Act. For 

purposes of the SRDP, a person 

submitting a disclosure to the SRDP will 

be referred to as a ‘‘disclosing party.’’ 

CMS analyzes the disclosed conduct to 

determine compliance with section 

1877 of the Act and the application of 

the exceptions to the physician selfreferral prohibition. 

Specifically, under the proposal a 

physician practice disclosing group 

practice noncompliance will submit an 

SRDP form consisting of the following 

components: (1) the SRDP Disclosure 

Form, (2) a single Group Practice 

Information Form covering all the 

physicians in the practice who made 

prohibited referrals to the practice, and 

(3) a Financial Analysis Worksheet. All 

other entities will continue to submit 

disclosures using the SRDP Disclosure 

Form, separate Physician Information 

Forms for each physician covered in the 

self-disclosure, and a Financial Analysis 

Worksheet. Form Number: CMS–10328 

(OMB control number: 0938–1106); 

Frequency: Yearly; Affected Public: 

Private Sector (Business or other forprofits, Not-for-Profit Institutions); 

Number of Respondents: 100; Total 

Annual Responses: 200; Total Annual 

Hours: 5,000. (For policy questions 

regarding this collection contact 

Matthew Edgar at 410–786–0698.) 

Dated: June 3, 2022. 

William N. Parham, III, 

Director, Paperwork Reduction Staff, Office 

of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2022–12379 Filed 6–8–22; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

[OMB No. 0970–0174] 

Submission for OMB Review; Native 

Employment Works (NEW) Plan 

Guidance and NEW Program Report 

AGENCY: Division of Tribal TANF 

Management, Office of Family 

Assistance, Administration for Children 

and Families, HHS. 

ACTION: Request for public comment. 

SUMMARY: The Administration for 

Children and Families (ACF) is 

requesting a 3-year extension of the 

form OFA–0086: NEW Plan Guidance 

and NEW Program Report (OMB #0970– 

0174, expiration 8/31/2022). There are 

minor changes requested to both 

documents. 

DATES: Comments due within 30 days of 

publication. OMB must make a decision 

about the collection of information 

between 30 and 60 days after 

publication of this document in the 

Federal Register. Therefore, a comment 

is best assured of having its full effect 

if OMB receives it within 30 days of 

publication. 

ADDRESSES: Written comments and 

recommendations for the proposed 

information collection should be sent 

within 30 days of publication of this 

notice to www.reginfo.gov/public/do/ 

PRAMain. Find this particular 

information collection by selecting 

‘‘Currently under 30-day Review—Open 

for Public Comments’’ or by using the 

search function. You can also obtain 

copies of the proposed collection of 

information by emailing infocollection@

acf.hhs.gov. Identify all emailed 

requests by the title of the information 

collection. 

SUPPLEMENTARY INFORMATION: 

Description: The NEW Program Plan 

Guidance documents specify the 

information needed to complete a NEW 

program plan and explain the process 

for plan submission every third year and 

to complete the annual program report. 

The program plan is the application for 

NEW program funding and documents 

how the grantee will carry out its NEW 


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