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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35220 Federal Register / Vol. 87, No. 111 / Thursday, June 9, 2022 / Notices 

program. ACF proposes a change in how 

draft plans are submitted. The program 

report provides HHS, Congress, and 

grantees information to document and 

assess the activities and 

accomplishments of the NEW program. 

ACF proposes to extend data collection 

with revisions that clarify that programs 

should not count more than once 

individuals who meet multiple 

categories; for example, persons age 20 

are both youth and adults, but they 

should be counted as one or the other, 

not both. 

Respondents: Indian tribes and tribal 

coalitions that operate NEW programs. 

ANNUAL BURDEN ESTIMATES

Instrument 

Total number 

of respondents 

(over 3 yrs.) 

Annual 

number of 

responses per 

respondent 

Average 

burden hours 

per response 

Annual 

burden hours 

NEW Program Plan Guidance ......................................................................... 40 1.333 29 386 

NEW Program Report ...................................................................................... 40 1 15 600 

Total Estimated Annual Burden ............................................................... ........................ ........................ ........................ 986 

1We have used .333 responses per year to represent one submission of the NEW Program Plan Guidance during the 3-year approval period. 

Authority: 42 U.S.C. 612. 

Mary B. Jones, 

ACF/OPRE Certifying Officer. 

[FR Doc. 2022–12424 Filed 6–8–22; 8:45 am] 

BILLING CODE 4184–36–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Health Resources and Services 

Administration 

Agency Information Collection 

Activities: Proposed Collection: Public 

Comment Request; Maternal and Child 

Health Bureau Performance Measures 

for Discretionary Grant Information 

System (DGIS), OMB No. 0915–0298— 

Revision 

AGENCY: Health Resources and Services 

Administration (HRSA), Department of 

Health and Human Services. 

ACTION: Notice. 

SUMMARY: In compliance with the 

Paperwork Reduction Act of 1995, 

HRSA has submitted an Information 

Collection Request (ICR) to the Office of 

Management and Budget (OMB) for 

review and approval. Comments 

submitted during the first public review 

of this ICR will be provided to OMB. 

OMB will accept further comments from 

the public during the review and 

approval period. OMB may act on 

HRSA’s ICR only after the 30-day 

comment period for this Notice has 

closed. 

DATES: Comments on this ICR should be 

received no later than 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 Review—Open for 

Public Comments’’ or by using the 

search function. 

FOR FURTHER INFORMATION CONTACT: To 

request a copy of the clearance requests 

submitted to OMB for review, email 

Samantha Miller, the acting HRSA 

Information Collection Clearance Officer 

at paperwork@hrsa.gov or call (301) 

443–9094. 

SUPPLEMENTARY INFORMATION: 

Information Collection Request Title: 

Maternal and Child Health Bureau 

(MCHB) Performance Measures for 

Discretionary Grant Information System 

(DGIS), OMB No. 0915–0298—Revision. 

Abstract: Approval from OMB is 

sought to implement minor revisions to 

the MCHB Performance Measures for 

DGIS. Most of these measures are 

specific to certain types of programs and 

are not required of all grantees. The 

measures are categorized by domain 

(Adolescent Health, Capacity Building, 

Child Health, Children with Special 

Health Care Needs, Lifecourse/ 

Crosscutting, Maternal/Women Health, 

and Perinatal/Infant Health), in addition 

to some program-specific measures. 

Grant programs are assigned domains 

based on their activities and individual 

grantees respond to only a limited 

number of performance measures that 

are relevant to their specific program. 

HRSA intends to change the 

numbering sequence of the DGIS forms 

in an approach different from what was 

outlined in the Federal Register notice 

(87 FR 3313) published on January 21, 

2022. The approach outlined in the 

January 21, 2022, notice provided for 

the re-use of form numbers by 

reordering the form sequence to 

accommodate the forms being removed 

and added. After further consideration, 

HRSA intends to retire the number 

associated with the six DGIS forms 

being removed and give the new DGIS 

Training form the next number in the 

numbering sequence (Training Form 15, 

which was previously labeled as 

Training Form 14 in the January 21, 

2022, notice). This streamlined 

approach will prevent confusion among 

grantees and HRSA when referencing 

the forms after they are updated in 

DGIS. 

No additional forms are proposed to 

be added, removed, or revised beyond 

what was specified in the January 21, 

2022, notice. As noted in the January 21, 

2022, notice, HRSA is making the 

following changes to the current 

information collection for MCHB DGIS 

to more closely align data collection 

forms with the program activities: 

Removing the following existing 

forms: Core 1 (Grant Impact), Capacity 

Building 2 (Technical Assistance), 

Capacity Building 7 (Direct Annual 

Access to MCH Data), Training Form 13 

(Diverse Adolescent Involvement 

(Leadership Education in Adolescent 

Health Program –specific)), Financial 

Form 2 (Project Funding Profile), and 

Financial Form 4 (Project Budget and 

Expenditures); 

Adding the following new forms: 

Training Form 15 (Consultation and 

Training for Mental and Behavioral 

Health) and Leadership, Education, and 

Advancement in Undergraduate 

Pathways Training Program Trainee 

Information Form. The title of Training 

Form 15 was changed from 

‘‘Teleconsultation’’ to ‘‘Consultation’’ to 

acknowledge that some programs that 

report on this form may also have an inperson consultation component. 

Therefore, the form was updated to 

capture both teleconsults and in-person 

consults and the title was adjusted to 

represent this change; 

Revising the following existing forms: 

F2F (Family to Family Form 1), 

Financial Form 1 (MCHB Project Budget 

Details), Financial Form 4 (new name: 


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