50274 Federal Register / Vol. 73, No. 166 / Tuesday, August 26, 2008 / Proposed Rules 

state law. For that reason, this proposed 

action: 

• Is not a ‘‘significant regulatory 

action’’ subject to review by the Office 

of Management and Budget under 

Executive Order 12866 (58 FR 51735, 

October 4, 1993); 

• Does not impose an information 

collection burden under the provisions 

of the Paperwork Reduction Act (44 

U.S.C. 3501 et seq.); 

• Is certified as not having a 

significant economic impact on a 

substantial number of small entities 

under the Regulatory Flexibility Act (5 

U.S.C. 601 et seq.); 

• Does not contain any unfunded 

mandate or significantly or uniquely 

affect small governments, as described 

in the Unfunded Mandates Reform Act 

of 1995 (Pub. L. 104–4); 

• Does not have Federalism 

implications as specified in Executive 

Order 13132 (64 FR 43255, August 10, 

1999); 

• Is not an economically significant 

regulatory action based on health or 

safety risks subject to Executive Order 

13045 (62 FR 19885, April 23, 1997); 

• Is not a significant regulatory action 

subject to Executive Order 13211 (66 FR 

28355, May 22, 2001); 

• Is not subject to requirements of 

Section 12(d) of the National 

Technology Transfer and Advancement 

Act of 1995 (15 U.S.C. 272 note) because 

application of those requirements would 

be inconsistent with the CAA; and 

• Does not provide EPA with the 

discretionary authority to address, as 

appropriate, disproportionate human 

health or environmental effects, using 

practicable and legally permissible 

methods, under Executive Order 12898 

(59 FR 7629, February 16, 1994). 

In addition, this proposed rule, 

pertaining to the Philadelphia County 

RACT under the 8-hour ozone NAAQS, 

does not have tribal implications as 

specified by Executive Order 13175 (65 

FR 67249, November 9, 2000), because 

the SIP is not approved to apply in 

Indian country located in the state, and 

EPA notes that it will not impose 

substantial direct costs on tribal 

governments or preempt tribal law. 

List of Subjects in 40 CFR Part 52 

Environmental protection, Air 

pollution control, Nitrogen dioxide, 

Ozone, Reporting and recordkeeping 

requirements, Volatile organic 

compounds. 

Authority: 42 U.S.C. 7401 et seq. 

Dated: August 18, 2008. 

William T. Wisniewski, 

Acting Regional Administrator, Region III. 

[FR Doc. E8–19753 Filed 8–25–08; 8:45 am] 

BILLING CODE 6560–50–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

45 CFR Part 88 

RIN 0991–AB48 

Ensuring That Department of Health 

and Human Services Funds Do Not 

Support Coercive or Discriminatory 

Policies or Practices In Violation of 

Federal Law 

AGENCY: Office of the Secretary, HHS. 

ACTION: Proposed rule. 

SUMMARY: The Department of Health and 

Human Services proposes to promulgate 

regulations to ensure that Department 

funds do not support morally coercive 

or discriminatory practices or policies 

in violation of federal law, pursuant to 

the Church Amendments (42 U.S.C. 

300a–7), Public Health Service (PHS) 

Act § 245 (42 U.S.C. 238n), and the 

Weldon Amendment (Consolidated 

Appropriations Act, 2008, Pub. L. 110–

161, § 508(d), 121 Stat. 1844, 2209). This 

notice of proposed rulemaking proposes 

to define certain key terms. 

Furthermore, in order to ensure that 

recipients of Department funds know 

about their legal obligations under these 

nondiscrimination provisions, the 

Department proposes to require written 

certification by certain recipients that 

they will comply with all three statutes, 

as applicable. 

DATES: Submit written or electronic 

comment on the regulations proposed 

by this document by September 25, 

2008. 

ADDRESSES: In commenting, please refer 

to ‘‘Provider Conscience Regulation’’. 

Because of staff and resource 

limitations, we cannot accept comments 

by facsimile (FAX) transmission. 

You may submit comments in one of 

four ways (no duplicates, please): 

1. Electronically. You may submit 

electronic comments on this regulation 

to http://www.Regulations.gov or via email to consciencecomment@hhs.gov. 

To submit electronic comments to 

http://www.Regulations.gov, go to the 

Web site and click on the link 

‘‘Comment or Submission’’ and enter 

the keywords ‘‘provider conscience’’. 

(Attachments should be in Microsoft 

Word, WordPerfect, or Excel; however, 

we prefer Microsoft Word.) 

2. By regular mail. You may mail 

written comments (one original and two 

copies) to the following address only: 

Office of Public Health and Science, 

Department of Health and Human 

Services, Attention: Brenda Destro, 

Hubert H. Humphrey Building, 200 

Independence Avenue, SW., Room 

728E, Washington, DC 20201. 

3. By express or overnight mail. You 

may send written comments (one 

original and two copies) to the following 

address only: Office of Public Health 

and Science, Department of Health and 

Human Services, Attention: Brenda 

Destro, Hubert H. Humphrey Building, 

200 Independence Avenue, SW., Room 

728E, Washington, DC 20201. 

4. By hand or courier. If you prefer, 

you may deliver (by hand or courier) 

your written comments (one original 

and two copies) before the close of the 

comment period to the following 

address: Room 728E, Hubert H. 

Humphrey Building, 200 Independence 

Avenue, SW., Washington, DC 20201. 

(Because access to the interior of the 

Hubert H. Humphrey Building is not 

readily available to persons without 

Federal Government Identification, 

commenters are encouraged to leave 

their comments in the mail drop slots 

located in the main lobby of the 

building. A stamp-in clock is available 

for persons wishing to retain proof of 

filing by stamping in and retaining and 

extra copy of the documents being 

filed.) 

Comments mailed to the addresses 

indicated as appropriate for hand or 

courier delivery may be delayed and 

received after the comment period. 

Submitting Comments: We welcome 

comments from the public on all issues 

set forth in this proposed rule to assist 

us in fully considering issues and 

developing policies. For all comments 

submitted, you should specify the 

subject as ‘‘Provider Conscience 

Regulation’’. 

Inspection of Public Comments: All 

comments received before the close of 

the comment period are available for 

viewing by the public, including any 

personally identifiable or confidential 

business information that is included in 

a comment. We post all comments 

received before the close of the 

comment period on the following Web 

site as soon as possible after they have 

been received: http:// 

www.Regulations.gov. Click on the link 

‘‘Comment or Submission’’ on that Web 

site to view public comments. 

Comments received timely will also 

be available for public inspection as 

they are received, generally beginning 

approximately 3 weeks after publication 

of a document, at the headquarters of 


sroberts on PROD1PC76 with PROPOSALS
Federal Register / Vol. 73, No. 166 / Tuesday, August 26, 2008 / Proposed Rules 50275 

the Department of Health and Human 

Services, Hubert H. Humphrey Building, 

200 Independence Avenue, SW., 

Washington, DC 20201, Monday 

through Friday of each week from 8:30 

a.m. to 4 p.m. 

Electronic Access 

This Federal Register document is 

also available from the Federal Register 

online database through GPO Access, a 

service of the U.S. Government Printing 

Office. Free public access is available on 

a Wide Area Information Server (WAIS) 

through the Internet and via 

asynchronous dial-in. Internet users can 

access the database by using the World 

Wide Web (the Superintendent of 

Documents’ home page address is 

http://www.gpoaccess.gov/), by using 

local WAIS client software, or by telnet 

to swais.access.gpo.gov, then login as 

guest (no password required). Dial-in 

users should used communications 

software and modem to call (202) 512–

1661; type swais, then login as guest (no 

password required). 

FOR FURTHER INFORMATION CONTACT: 

Brenda Destro, (202) 401–2305, Office of 

Public Health and Science, Department 

of Health and Human Services, Room 

728E, Hubert H. Humphrey Building, 

200 Independence Avenue, SW., 

Washington, DC 20201. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Religious liberty and freedom of 

conscience have long been protected in 

the Constitution and laws of the United 

States. Workers in all sectors of the 

economy enjoy legal protection of their 

consciences and religious liberties. In 

federal law, there are several provisions 

that prohibit recipients of certain federal 

funds from coercing individuals in the 

health care field into participating in 

actions they find religiously or morally 

objectionable. These same provisions 

also prohibit discrimination on the basis 

of one’s objection to, participation in, or 

refusal to participate in, specific 

medical procedures, including abortion 

or sterilization. In addition, there is a 

provision that prohibits the federal 

governments and state and local 

governments from discriminating 

against individual and institutional 

providers who refuse, among other 

things, to receive training in abortions, 

require or provide such training, 

perform abortions, or refer for or make 

arrangements for abortions or training in 

abortions. More recently, an 

appropriations provision has been 

enacted that prohibits certain federal 

agencies and programs and State and 

local governments that receive certain 

federal funds from discriminating 

against individuals and institutions that 

refuse to, among other things, provide, 

refer for, pay for, or cover, abortion. 

Conscience Clauses/Church 

Amendments [42 U.S.C. 300a–7] 

The conscience provisions contained 

in 42 U.S.C. 300a–7 (collectively known 

as the ‘‘Church Amendments’’) were 

enacted at various times during the 

1970s in response to debates over 

whether receipt of federal funds 

required the recipients of such funds to 

provide abortions or sterilizations. The 

first conscience provision in the Church 

Amendments, 42 U.S.C. 300a–7(b), 

provides that ‘‘[t]he receipt of any grant, 

contract, loan, or loan guarantee under 

[certain statutes implemented by the 

Department of Health and Human 

Services] * * * by any individual or 

entity does not authorize any court or 

any public official or other public 

authority to require’’: (1) The individual 

to perform or assist in a sterilization 

procedure or an abortion, if it would be 

contrary to his/her religious beliefs or 

moral convictions; (2) the entity to make 

its facilities available for sterilization 

procedures or abortions, if the 

performance of sterilization procedures 

or abortions in the facilities is 

prohibited by the entity on the basis of 

religious beliefs or moral convictions; or 

(3) the entity to provide personnel for 

the performance of sterilization 

procedures or abortions, if it would be 

contrary to the religious beliefs or moral 

convictions of such personnel. 

The second conscience provision in 

the Church Amendments, 42 U.S.C. 

300a–7(c)(1), prohibits any entity which 

receives a grant, contract, loan, or loan 

guarantee under certain Departmentimplemented statutes from 

discriminating against any physician or 

other health care personnel in 

employment, promotion, termination of 

employment, or the extension of staff or 

other privileges because the individual 

either ‘‘performed or assisted in the 

performance of a lawful sterilization 

procedure or abortion,’’ or ‘‘because he 

refused to perform or assist in the 

performance of such a procedure or 

abortion on the grounds that his 

performance or assistance in the 

performance of the procedure or 

abortion would be contrary to his 

religious beliefs or moral convictions, or 

because of his religious beliefs or moral 

convictions respecting sterilization 

procedures or abortions.’’

The third conscience provision, 

contained in 42 U.S.C. 300a–7(c)(2), 

prohibits any entity which receives a 

grant or contract for biomedical or 

behavioral research under any program 

administered by the Department from 

discriminating against any physician or 

other health care personnel in 

employment, promotion, termination of 

employment, or extension of staff or 

other privileges ‘‘because he performed 

or assisted in the performance of any 

lawful health service or research 

activity,’’ or ‘‘because he refused to 

perform or assist in the performance of 

any such service or activity on the 

grounds that his performance of such 

service or activity would be contrary to 

his religious beliefs or moral 

convictions, or because of his religious 

beliefs or moral convictions respecting 

any such service or activity.’’

The fourth conscience provision, 42 

U.S.C. 300a–7(d), provides that ‘‘[n]o 

individual shall be required to perform 

or assist in the performance of any part 

of a health service program or research 

activity funded in whole or in part 

under a program administered by [the 

Department] if his performance or 

assistance in the performance of such 

part of such program or activity would 

be contrary to his religious beliefs or 

moral convictions.’’

The final conscience provision 

contained in the Church Amendments, 

42 U.S.C. 300a–7(e), prohibits any entity 

that receives a grant, contract, loan, or 

loan guarantee under certain 

Departmentally implemented statutes 

from denying admission to, or otherwise 

discriminating against, ‘‘any applicant 

(including for internships and 

residencies) for training or study 

because of the applicant’s reluctance, or 

willingness, to counsel, suggest, 

recommend, assist, or in any way 

participate in the performance of 

abortions or sterilizations contrary to or 

consistent with the applicant’s religious 

beliefs or moral convictions.’’

Public Health Service Act § 245 [42 

U.S.C. 238n] 

Enacted in 1996, section 245 of the 

Public Health Service Act (PHS Act) 

prohibits the federal government and 

any State or local government receiving 

federal financial assistance from 

discriminating against any health care 

entity on the basis that the entity: (1) 

Refuses to receive training in the 

performance of abortions, to require or 

provide such training, to perform such 

abortions, or to provide referrals for 

such training or such abortions; (2) 

refuses to make arrangements for such 

activities; or (3) attends or attended a 

post-graduate physician training 

program or any other training program 

in the health professions that does not 

(or did not) perform abortions or 

require, provide, or refer for training in 

the performance of abortions or make 


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50276 Federal Register / Vol. 73, No. 166 / Tuesday, August 26, 2008 / Proposed Rules 

1 ‘‘HHS Secretary Calls on Certification Group to 

Protect Conscience Rights,’’ March 14, 2008. 

Available at http://www.hhs.gov/news/press/ 

2008pres/03/20080314a.html. 

arrangements for the provision of such 

training. In addition, PHS Act § 245 

requires that, in determining whether to 

grant legal status to a health care entity 

(including a State’s determination of 

whether to issue a license or certificate 

such as a medical license), the federal 

government and any State or local 

government receiving federal financial 

assistance deem accredited any postgraduate physician training program 

that otherwise would be accredited but 

for the reliance on an accrediting 

standard that requires an entity: (1) To 

perform induced abortions; or (2) to 

require, provide, or refer for training in 

the performance of induced abortions, 

or make arrangements for such training. 

Weldon Amendment [Consolidated 

Appropriations Act, 2008, Public Law 

No. 110–161, Div. G, § 508(d), 121 Stat. 

1844, 2209 (Dec. 26, 2007)] 

The Weldon Amendment, originally 

adopted as section 508(d) of the Labor–

HHS Division (Division F) of the 2005 

Consolidated Appropriations Act, 

Public Law 108–447 (Dec. 8, 2004), has 

been readopted (or incorporated by 

reference) in each subsequent HHS 

appropriations act. Title V of the 

Departments of Labor, Health and 

Human Services, and Education, and 

Related Agencies Appropriations Act, 

2006, Public Law 109–149, § 508(d), 119 

Stat. 2833, 2879–80; Revised Continuing 

Appropriations Resolution of 2007, 

Public Law 110–5, § 2, 121 Stat. 8, 9; 

Consolidated Appropriations Act, 2008, 

Public Law No. 110–161, Div. G, 

§ 508(d), 121 Stat. 1844, 2209. The 

Weldon Amendment provides that 

‘‘[n]one of the funds made available 

under this Act [making appropriations 

for the Departments of Labor, Health 

and Human Services, and Education] 

may be made available to a federal 

agency or program, or to a State or local 

government, if such agency, program, or 

government subjects any institutional or 

individual health care entity to 

discrimination on the basis that the 

health care entity does not provide, pay 

for, provide coverage of, or refer for 

abortions.’’ It also defines ‘‘health care 

entity’’ to include ‘‘an individual 

physician or other health care 

professional, a hospital, a providersponsored organization, a health 

maintenance organization, a health 

insurance plan, or any other kind of 

health care facility, organization, or 

plan.’’

The Laws in the Courts 

The federal courts have recognized 

the breadth and importance of statutory 

and other conscience protections for 

health care professionals and workers. 

Shortly after its passage, a federal 

appellate court decision characterized 

the importance of conscience 

protections contained in the Church 

Amendments. Faced with the question 

of a denominational hospital’s right to 

refuse to perform sterilization 

procedures, the Ninth Circuit affirmed a 

lower court decision protecting the 

hospital’s right to refuse to perform 

sterilizations and abortions on religious 

or moral grounds: ‘‘If [a] hospital’s 

refusal to perform sterilization [or, by 

implication, abortion] infringes upon 

any constitutionally cognizable right to 

privacy, such infringement is 

outweighed by the need to protect the 

freedom of religion of denominational 

hospitals ‘with religious or moral 

scruples against sterilizations and 

abortions.’ ’’ Taylor v. St. Vincent’s 

Hospital, 523 F.2d 75, 77 (9th Cir. 1975) 

(citations omitted). 

The Problem 

There appears to be an attitude 

toward the health care professions that 

health care professionals and 

institutions should be required to 

provide or assist in the provision of 

medicine or procedures to which they 

object, or else risk being subjected to 

discrimination. Reflecting this attitude, 

in some instances the standards of 

professional organizations have been 

used to define the exercise of 

conscience to be unprofessional, forcing 

health care professionals to choose 

between their capacity to practice in 

good standing and their right of 

conscience.1

Despite the fact that several 

conscience statutes protecting health 

care entities from discrimination have 

been in existence for decades, the 

Department is concerned that the public 

and many health care providers are 

largely uninformed of the protections 

afforded to individuals and institutions 

under these provisions. This lack of 

knowledge within the health 

professions can be detrimental to 

conscience and other rights, particularly 

for individuals and entities with moral 

objections to abortion and other medical 

procedures. 

The Department’s Response 

In general, the Department is 

concerned that the development of an 

environment in the health care field that 

is intolerant of individual conscience, 

certain religious beliefs, ethnic and 

cultural traditions, and moral 

convictions may discourage individuals 

from diverse backgrounds from entering 

health care professions. Such 

developments also promote the 

mistaken beliefs that rights of 

conscience and self-determination 

extend to all persons, except health care 

providers. Additionally, religious and 

faith-based organizations have a long 

tradition of providing medical care in 

the United States, and they continue to 

do so today—some of these are among 

the largest providers of health care in 

this nation. A trend that isolates and 

excludes some among various religious, 

cultural, and/or ethnic groups from 

participating in the delivery of health 

care is especially troublesome when 

considering current and anticipated 

shortages of health care professionals in 

many medical disciplines facing the 

country. 

The Department also notes that, while 

many recipients of Department funds 

currently must certify compliance with 

federal nondiscrimination laws, federal 

conscience protections are not 

mentioned in existing forms. For 

example, Form PHS–5161–1, required 

as part of Public Health Service grant 

applications, requires applicants to 

certify compliance with all federal 

nondiscrimination laws, including laws 

prohibiting discrimination on the basis 

of race, color, national origin, religion, 

sex, handicap, age, drug abuse, and 

alcohol abuse or alcoholism. The 

Department seeks to raise awareness of 

federal conscience laws by specifically 

including reference to the 

nondiscrimination provisions contained 

in the Church Amendments, PHS Act 

§ 245, and the Weldon Amendment in 

certifications currently required of most 

existing and potential recipients of 

Department funds. 

Toward these ends, the Department 

has concluded that regulations and 

related efforts are necessary, in order to 

(1) educate the public and health care 

providers on the obligations imposed, 

and protections afforded, by federal law; 

(2) work with State and local 

governments and other recipients of 

funds from the Department to ensure 

compliance with the nondiscrimination 

requirements embodied in the Church 

Amendments, PHS Act § 245, and the 

Weldon Amendment; (3) when such 

compliance efforts prove unsuccessful, 

enforce these nondiscrimination laws 

through the various Department 

mechanisms, to ensure that Department 

funds do not support morally coercive 

or discriminatory practices or policies 

in violation of federal law; and (4) 

otherwise take an active role in 

promoting open communication within 

the healthcare industry, and between 

providers and patients, fostering a more 


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2See Letter from Secretary Tommy G. Thompson 

to Hon. W.F. Tauzin, September 24, 2002. 

inclusive, tolerant environment in the 

health care industry than may currently 

exist. 

This regulation does not limit patient 

access to health care, but rather protects 

any individual health care provider or 

institution from being compelled to 

participate in, or from being punished 

for refusal to participate in, a service 

that, for example, violates their 

conscience. 

These proposed actions are consistent 

with the Administration’s current efforts 

to ensure that community and faithbased organizations are able to 

participate in federal programs on a 

level playing field with other 

organizations. 

II. Summary of the Proposed Rule 

This proposed rule sets out, and 

provides further definition of, the rights 

and responsibilities created by the 

federal nondiscrimination provisions. It 

clarifies the scope of nondiscrimination 

protections to applicable members of 

the Department’s workforce, as well as 

and health care entities and members of 

the workforces of entities receiving 

Department funds. This proposed rule 

would also require certain recipients of 

Department funds to certify compliance 

with these requirements. In order to 

ensure proper enforcement, this 

proposed rule would define certain 

terms for the purposes of this proposed 

regulation. 

The Office for Civil Rights of the 

Department of Health and Human 

Services has been designated to receive 

complaints of discrimination based on 

the nondiscrimination statutes and this 

proposed regulation. It will coordinate 

handling of complaints with the staff of 

the Departmental programs from which 

the entity with respect to whom a 

complaint has been filed receives 

funding. Enforcement of the 

requirements set forth in this proposed 

regulation will be conducted through 

the usual and ordinary program 

mechanisms. Compliance with the 

requirements proposed herein would 

likely be examined as part of any 

broader compliance review conducted 

by Department staff. If the Department 

becomes aware that a State or local 

government or an entity may be in 

violation of the requirements or 

prohibitions proposed herein, the 

Department would work with such 

government or entity to assist such 

government or entity to come into 

compliance with such requirements or 

prohibitions. If, despite the 

Department’s assistance, compliance is 

not achieved, the Department will 

consider all legal options, including 

termination of funding, return of funds 

paid out in violation of 

nondiscrimination provisions under 45 

CFR 74, and other measures. 

III. Statutory Authority 

On the basis of the above-mentioned 

statutory authority, the Secretary 

proposes to promulgate these 

regulations, requiring certification of 

compliance with the anti-discrimination 

statutes. 

The statutory provisions discussed 

above require that the Department and 

recipients of Department funds 

(including State and local governments) 

refrain from discriminating against 

institutional and individual health care 

entities for their participation or refusal 

to participate in certain medical 

procedures or services, including 

certain health services, or research 

activities funded in whole or in part by 

the Federal Government. The 

Department has authority to promulgate 

regulations to enforce these 

prohibitions. Finally, the Department 

also has the legal authority to require 

that recipients certify their compliance 

with these proposed requirements and 

to require their sub-recipients to 

likewise certify their compliance with 

these proposed requirements. In 

addition, 5 U.S.C. 301 empowers the 

head of an Executive department to 

prescribe regulations ‘‘for the 

government of his department, the 

conduct of its employees, the 

distribution and performance of its 

business, and the custody, use, and 

preservation of its records, papers, and 

property.’’

IV. Provisions of the Proposed Rule 

Section 88.1 Purpose 

The ‘‘Purpose’’ section of the 

regulation sets forth the objective that 

the proposed regulation would, when 

finalized, provide for the 

implementation and enforcement of 

federal nondiscrimination statutes 

protecting the conscience rights of 

health care entities. It also states that the 

statutory provisions and regulations 

contained in this Part are to be 

interpreted and implemented broadly to 

effectuate these protections. 

Section 88.2 Definitions 

Assist in the Performance: The 

Department, in considering how to 

interpret the term ‘‘assist in the 

performance,’’ seeks to provide broad 

protection for individuals’ consciences. 

The Department seeks to avoid judging 

whether a particular action is genuinely 

offensive to an individual. At the same 

time, the Department wishes to guard 

against potential abuses of these 

protections by limiting the definition of 

‘‘assist in performance’’ only to those 

actors who have a reasonable 

connection to the procedure, health 

service or health service program, or 

research activity to which they object. 

Therefore, the Department proposes to 

interpret this term broadly, as 

encompassing individuals who are 

members of the workforce of the 

Department-funded entity performing 

the objectionable procedure. When 

applying the term ‘‘assist in the 

performance’’ to members of an entity’s 

workforce, the Department proposes to 

include participation in any activity 

with a reasonable connection to the 

objectionable procedure, including 

referrals, training, and other 

arrangements for offending procedures. 

For example, an operating room nurse 

would assist in the performance of 

surgical procedures, and an employee 

whose task it is to clean the instruments 

used in a particular procedure would be 

considered to assist in the performance 

of the particular procedure. 

Health Care Entity/Entity: While both 

PHS Act § 245 and the Weldon 

Amendment provide examples of 

specific types of protected individuals 

and health care organizations, neither 

statute provides an exhaustive list of 

such health care entities. PHS Act § 245 

defines ‘‘health care entity’’ as 

‘‘includ[ing] an individual physician, a 

postgraduate physician training 

program, and a participant in a program 

of training in the health professions.’’

As the Department has previously 

indicated, the definition of ‘‘health care 

entity’’ in PHS Act § 245 also 

encompasses institutional entities, such 

as hospitals and other entities.2 The 

Weldon Amendment defines the term 

‘‘health care entity’’ as ‘‘includ[ing] an 

individual physician or other health 

care professional, a hospital, a providersponsored organization, a health 

maintenance organization, a health 

insurance plan, or any other kind of 

health care facility, organization, or 

plan.’’ The Church Amendment does 

not define the term ‘‘entity,’’ and does 

not use the term ‘‘health care entity.’’

In keeping with the definitions in 

PHS Act § 245 and the Weldon 

Amendment, the Department proposes 

to define ‘‘health care entity’’ to include 

the specifically mentioned organizations 

from the two statutes, as well as other 

types of entities referenced in the 

Church Amendments. It is important to 

note that the Department does not 

intend for this to be a comprehensive 

list of relevant organizations for 


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purposes of the regulation, but merely a 

list of examples. 

Health Service/Health Service 

Program: One of the provisions in the 

Church Amendments uses the term 

‘‘health service,’’ another uses the term, 

‘‘health service program.’’ Neither 

define the terms, nor does the PHS Act 

define ‘‘health service program.’’ In 

developing an appropriate definition for 

‘‘health service program,’’ we have 

looked at the Social Security Act. 

Section 1128B(f)(1) of the Social 

Security Act, 42 U.S.C. 1320a–7b(f)(1), 

defines a similar term, ‘‘federal health 

care program’’, as ‘‘any plan or program 

that provides health benefits, whether 

directly, through insurance, or 

otherwise, which is funded directly, in 

whole or in part, by the United States 

Government.’’

Building on this broad definition, we 

propose that the term ‘‘health service 

program’’ should be understood to 

include an activity related in any way 

to providing medicine, health care, or 

any other service related to health or 

wellness, including programs where the 

Department provides care directly (e.g., 

Indian Health Service); programs where 

grants pay for the provision of health 

services (e.g., Administration for 

Children and Families programs such as 

the Unaccompanied Refugee Minor and 

the Division of Unaccompanied 

Children Services programs and HRSA 

programs such as community health 

centers); programs where the 

Department reimburses another entity 

that provides care (e.g., Medicare); and 

health insurance programs where 

federal funds are used to provide access 

to health coverage (e.g., SCHIP, 

Medicaid, and Medicare Advantage). 

Similarly, we propose that the term 

‘‘health service’’ means any service so 

provided. 

Individual: For the purposes of this 

part, the Department proposes to define 

‘‘individual’’ to mean a member of the 

workforce (see definition of ‘‘workforce’’

below) of an entity or health care entity. 

One conscience clause of the Church 

Amendments, 42 U.S.C. 300a–7(d), 

provides that ‘‘[n]o individual shall be 

required to perform or assist in the 

performance of any part of a health 

service program or research activity 

funded in whole or in part under a 

program administered by the Secretary 

of Health, Education and Welfare 

[Secretary of Health and Human 

Services] if his performance or 

assistance in the performance of such 

part of such program or activity would 

be contrary to his religious beliefs or 

moral convictions (emphasis added).’’

Instrument: We propose to use 

‘‘instrument’’ to mean the variety of 

means by which the Department 

conveys funding and resources to 

organizations, including: grants, 

cooperative agreements, contracts, 

grants under a contract, and memoranda 

of understanding. The definition of 

‘‘instrument’’ is intended to include all 

means by which the Department 

conveys funding and resources. 

Recipient: This term is used to 

encompass any entity that receives 

Department funds directly. 

Sub-recipient: This term is used to 

encompass any entity that receives 

Department funds indirectly through a 

recipient or sub-recipient. 

Workforce: We propose to define 

‘‘workforce’’ as including employees, 

volunteers, trainees, and other persons 

whose conduct, in the performance of 

work for an entity, is under the control 

or authority of such entity, whether or 

not they are paid by the Departmentfunded entity. The definition is drawn 

from the ‘‘Administrative Data 

Standards and Related Requirements’’

rules implementing Health Insurance 

Portability and Accountability Act 

(HIPAA), 45 CFR Parts 160, 162, and 

164 (2006) at 45 CFR 160.103. In 

keeping with this definition, persons 

and organizations under contract with 

an entity, if they are under the control 

or authority of the entity, would be 

considered members of the entity’s 

workforce. 

In defining both ‘‘individual’’ and 

‘‘workforce,’’ the Department proposes 

definitions that provide a reasonable 

scope for the natural persons protected 

by 42 U.S.C. 300a–7(d) and the 

corresponding provisions of these 

regulations. By limiting the scope of 

persons protected by these regulations 

to those who are under the control or 

authority of an entity that implements a 

health service program or research 

activity funded in whole or in part 

under a program administered by the 

Department, we propose to provide the 

bright line necessary for Departmentfunded entities subject to the applicable 

Church Amendment provisions to set 

policies or otherwise take steps to 

secure conscience protections within 

the workplace and, thus, to comply with 

the Church Amendment and these 

regulations. 

Section 88.3 Applicability 

The proposed ‘‘Applicability’’ section 

of the regulation outlines the 

certifications various entities must 

provide in order to receive Department 

funds. This section would direct entities 

to the appropriate sections that contain 

the relevant requirements from the three 

statutes that form the basis of this 

regulation. 

Section 88.4 Requirements and 

Prohibitions 

The ‘‘Requirements and Prohibitions’’

section explains the obligations that the 

Church Amendments, PHS Act § 245, 

and the Weldon Amendment impose on 

entities which receive funding from the 

Department. These provisions are taken 

from the relevant statutory language and 

make up the elements of the 

certification provided by the entities. 

We intend for the proposed 

requirements and prohibitions to be 

interpreted using the definitions 

proposed in section 88.2. 

Section 88.5 Written Certification of 

Compliance 

In the ‘‘Written Certification of 

Compliance’’ section of the regulation, 

the Department seeks to require certain 

recipients and sub-recipients of 

Department funds to certify compliance 

with the Church Amendments, PHS Act 

§ 245, and the Weldon Amendment, as 

applicable, and to provide for the 

affected recipients and sub-recipients 

requirements for collecting, 

maintaining, and submitting written 

certifications. 

We are concerned that there is a lack 

of knowledge on the part of States, local 

governments, and the health care 

industry of the rights of health care 

entities created by, and the 

corresponding obligations imposed on 

the recipients of certain federal funding 

by, the non-discrimination provisions. 

Under this proposed rule, recipients of 

federal funds would be required to 

submit their certifications directly to the 

Department as part of the instrument or 

in a separate writing signed by the 

recipients’ officer or other person 

authorized to bind the recipient. They 

would also be required to collect and 

maintain certifications by sub-recipients 

who receive Department funds through 

them. 

The proposed regulation requires that 

entities certify in writing that they will 

operate in compliance with the Church 

Amendments, PHS Act § 245, and the 

Weldon Amendment as applicable. 

Certification provides a demonstrable 

way of ensuring that the recipients of 

such funding know of, and attest that 

they will comply with, the applicable 

nondiscrimination provisions. Subrecipients of federal funds—entities that 

will receive federal funds indirectly 

through another entity (a recipient or 

other sub-recipient)—are required to 

provide certification as set out in the 

‘‘Sub-recipient’’ subsection of the 

‘‘Certification of Compliance’’ section, 

and submit them to the recipients 


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through which they receive Department 

funds for maintenance. 

Although it is collected and 

maintained by the recipient, this 

certification by sub-recipients is a 

certification addressed to the 

Department, not to the recipients 

collecting the certification. Recipients 

are expected to comply with 

requirements for retention of and access 

to records set forth in 45 CFR 74.53. 

While all recipients and subrecipients of Department funds are 

required to comply with the Church 

Amendments, PHS Act § 245, and the 

Weldon Amendment, as applicable, 

section 88.5(e) contains three important 

exceptions from the requirement to 

provide the written certification: (1) 

Physicians, physician offices, and other 

health care practitioners participating in 

Part B of the Medicare program; (2) 

physicians, physician offices, or other 

health care practitioners which 

participates in Part B of the Medicare 

program, when such individuals or 

organizations are sub-recipients of 

Department funds through a Medicare 

Advantage plan; and (3) sub-recipients 

of state Medicaid programs (i.e., any 

entity that is paid for services by the 

state Medicaid program). While other 

providers participating in the Medicare 

program as well as state Medicaid 

programs would be required to submit 

written certification of compliance to 

the Department, the large number of 

entities included in these three 

categories poses significant 

implementation hurdles for 

Departmental components and 

programs. Furthermore, the Department 

believes that, due primarily to their 

generally smaller size, the excepted 

categories of recipients and subrecipients of Department funds are less 

likely to encounter the types of issues 

sought to be addressed in this 

regulation. However, excepted providers 

may become subject to the written 

certification requirement by nature of 

their receiving Department funds under 

a separate agency or program. For 

example, a physician office 

participating in Medicare Part B may 

become subject to the written 

certification requirement by receiving 

Department funds to conduct clinical 

research. We note, however, that the 

State Medicaid programs are responsible 

for ensuring the compliance of their 

sub-recipients as part of ensuring that 

the State Medicaid program is operated 

consistently with applicable 

nondiscrimination provisions. The 

Department is considering whether 

other recipients of Department funds 

from programs that do not involve the 

provision of health care should also be 

excepted from the certification 

requirement and we seek comment on 

this issue. 

When finalized, individual 

Department components will be tasked 

with determining how best to 

implement the written certification 

requirements set out in this regulation 

in a way that ensures efficient program 

operation. To this end, Department 

components will be given discretion to 

phase in the written certification 

requirement by no later than the 

beginning of the next federal fiscal year 

following the effective date of the 

regulation. 

V. Request for Comment 

The Department, in order to craft its 

final rule to best reflect the environment 

within the health care field, seeks 

comment on this Proposed Rule. In 

particular, the Department seeks the 

following: 

• Comment on all issues raised by the 

proposed regulation. 

• Information with regard to general 

knowledge or lack thereof of the 

protections established by these 

nondiscrimination provisions, including 

any facts, surveys, audits, reports, or 

any other evidence of knowledge or lack 

of knowledge on these matters in the 

general public, as well as within the 

healthcare industry and educational 

institutions. 

• In the past, there has been some 

confusion about whether the receipt of 

federal funds permitted public officials 

to require entities to provide abortions 

or perform sterilizations. The debate 

was resolved, and statutory provisions 

like section (b) of the Church 

Amendments [42 U.S.C. 300a–7(b)] were 

promulgated to protect entities from 

public authorities who would claim that 

the receipt of federal funds creates a 

legal obligation for the entity to provide 

abortions or sterilization procedures. 

The Department seeks information, 

including any facts, surveys, audits, or 

reports on whether this remains an 

issue, that is, do public authorities 

continue to claim that the receipt of 

federal funds is sufficient basis for 

entities to be required to provide 

abortions or perform sterilizations? If so, 

how should the Department address this 

problem? 

• Comment on whether written 

certification of compliance with 

nondiscrimination provisions should 

contain language specifying that the 

certification is a material prerequisite to 

the payment of Department funds. 

• The Department also seeks 

comment on what constitutes the most 

effective methods of educating 

recipients of Department funds, their 

employees, and participants of the 

protections against discrimination 

found in the Church Amendments, PHS 

Act § 245, and the Weldon Amendment. 

What is the best method for 

communicating to the public the 

protections afforded by these statutes, 

and any regulation implementing them? 

Æ One option is to require the 

physical posting of notices of 

nondiscrimination protections in 

conspicuous places within the buildings 

of recipients of funds, and on 

applications to educational programs 

that are recipients of funds. Have 

notices been effective educational tools 

with respect to individuals’ rights under 

federal law? 

Æ Another option is to require 

inclusion of nondiscrimination 

protections in notice of applications for 

training, residency, and educational 

programs. 

Æ Another option is requiring notice 

of nondiscrimination protections on 

websites and in employee/volunteer 

handbooks of recipients. 

The Department seeks further 

comment on this matter—both on the 

merit of the options mentioned, and on 

any other means of educating the public 

with respect to the nondiscrimination 

protections under federal law. 

• Comment on whether there are 

recipients of Department funds that 

should be excepted from the proposed 

certification requirement, for example 

because the program under which such 

recipients receive Department funds is 

unrelated to the provision of health care 

or medical research. 

VI. Impact Analysis 

Executive Order 12866—Regulatory 

Planning and Review 

HHS has examined the economic 

implications of this proposed rule as 

required by Executive Order 12866. 

Executive Order 12866 directs agencies 

to assess all costs and benefits of 

available regulatory alternatives and, 

when regulation is necessary, to select 

regulatory approaches that maximize 

net benefits (including potential 

economic, environmental, public health 

and safety, and other advantages; 

distributive impacts; and equity). 

Executive Order 12866 classifies a rule 

as significant if it meets any one of a 

number of specified conditions, 

including: having an annual effect on 

the economy of $100 million, adversely 

affecting a sector of the economy in a 

material way, adversely affecting 

competition, or adversely affecting jobs. 

A regulation is also considered a 

significant regulatory action if it raises 

novel legal or policy issues. HHS has 


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3The [* * *] suggestion that the requirement to 

provide options counseling [including abortion 

counseling] should not apply to employees of a 

grantee who object to providing such counseling on 

moral or religious grounds, is likewise rejected 

[* * *] [S]uch a requirement is not necessary: 

under 42 U.S.C. 300a–7(d), grantees may not 

require individual employees who have such 

objections to provide such counseling (emphasis 

added). 65 FR 41270 (July 3, 2000) [codified at 42 

CFR 59 (2008)]; see also Letter from Secretary 

Tommy G. Thompson to Hon. W.F. Tauzin, 

September 24, 2002. 

determined that this proposed rule is a 

significant regulatory action as defined 

by Executive Order 12866. 

An underlying assumption of this 

regulation is that the health care 

industry, including entities receiving 

Department funds, will benefit from 

more diverse and inclusive workforces 

by informing health care workers of 

their rights and fostering an 

environment in which individuals and 

organizations from many different 

faiths, cultures, and philosophical 

backgrounds are encouraged to 

participate. As a result, we cannot 

accurately account for all of the 

regulation’s future benefits, but the 

Department believes the future benefits 

will exceed the costs of complying with 

the regulation. 

The statutes mandating the 

requirements for protecting health care 

entities and individuals in the health 

care industry as discussed in this rule 

have been in effect for a number of years 

and the proposed regulations are 

consistent with prior Departmental 

interpretations of these 

nondiscrimination statutes; 3 therefore, 

the regulatory burden associated with 

this rule, if finalized, is largely 

associated with the incremental costs of 

a recipient certifying compliance to the 

federal government and the cost of 

collecting and maintaining records of 

certification statements from subrecipients. We estimate the universe and 

number of entities that would be 

required to certify to be, at most, 

584,294 (see Table I). We do not 

distinguish between recipients and subrecipients of HHS funding. Each entity 

could be a recipient, a sub-recipient, or 

both. In accordance with subsection 

88.5(e) below, physicians, physician 

offices, and other health care 

practitioners participating in Medicare 

Part B or who are sub-recipients 

assisting in the implementation of a 

State Medicaid program are not subject 

to the written certification requirement; 

however, a high estimate of the number 

of physician offices and offices of other 

health care practitioners who may be 

required to certify as recipients or subrecipients of Department funds through 

other programs, instruments, or 

mechanisms is included. 

TABLE I—AFFECTED ENTITIES

Health care entity Number of 

entities 

Hospitals (less than 100 beds) 1 .............................................................................................................................................................. 2,403 

Hospitals (100–200 beds) 4 ..................................................................................................................................................................... 1,129 

Hospitals (200–500 beds) 4 ..................................................................................................................................................................... 1,160 

Hospitals (more than 500 beds) 4 ............................................................................................................................................................ 244 

Nursing Homes (less than 50 beds) 2 ..................................................................................................................................................... 2,388 

Nursing Homes (50–99 beds) 5 ............................................................................................................................................................... 5,819 

Nursing Homes (99–199 beds) 5 ............................................................................................................................................................. 6,877 

Nursing Homes (more than 200 beds) 5 .................................................................................................................................................. 1,037 

Physicians Offices 3 ................................................................................................................................................................................. 234,200 

Offices of Other Health CarePractitioners 6 4 .......................................................................................................................................... 115,378 

Outpatient Care Centers 6 5 ..................................................................................................................................................................... 26,901 

Medical and Diagnostic Laboratories 6 .................................................................................................................................................... 11,856 

Home Health Care Services 6 .................................................................................................................................................................. 20,184 

Pharmacies (chain and independent) 6 ................................................................................................................................................... 58,109 

Dental Schools 7 ...................................................................................................................................................................................... 56 

Medical Schools (Allopathic) 4 ................................................................................................................................................................. 125 

Medical Schools (Osteopathic) 4 .............................................................................................................................................................. 20 

Nursing Schools (Licensed practical) 8 .................................................................................................................................................... 1,138 

Nursing Schools (Baccalaureate) 11 ........................................................................................................................................................ 550 

Nursing Schools (Associate degree) 11 ................................................................................................................................................... 885 

Nursing Schools (Diploma) 11 .................................................................................................................................................................. 78 

Occupational Therapy Schools 4 ............................................................................................................................................................. 142 

Optometry Schools 4 ................................................................................................................................................................................ 17 

Pharmacy Schools 4 ................................................................................................................................................................................. 92 

Podiatry Schools 4 .................................................................................................................................................................................... 7 

Public Health Schools 4 ........................................................................................................................................................................... 37 

Residency Programs (accredited) 9 ......................................................................................................................................................... 8,494 

Health Insurance Carriers and 3rd-Party Administrators 10 .................................................................................................................... 4,578 

Grant awards 11 ....................................................................................................................................................................................... 76,088 

Contractors 12 ........................................................................................................................................................................................... 4,245 

State and territorial governments ............................................................................................................................................................ 57 

Total .................................................................................................................................................................................................. 584,294 

1 Health, United States, 2007. U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for 

Health Statistics. Nov. 2007. 2 Nursing Home Data Compendium, 2007 edition. U.S. Dept. of Health and Human Services, Centers for Medicaid and Medicare Services. 3 NPRM: Modification to Medical Data Code Set Standards to Adopt ICD–10–CM and ICD–10–PCS. 4From the NAICS Code 6213—Office of Other Health Care Practitioners (including Chiropractors, Optometrists, non-Physician Mental Health 

Practitioners, Physical Occupational and Speech Therapists, Podiatrists, and all other Miscellaneous Health Care Practitioners). 5From the NAICS Code 6214—Outpatient Care Centers (including Family Planning Centers, Outpatient Mental Health and Substance Abuse 

Centers, Other Outpatient Care Centers, HMO Medical Centers, Kidney Dialysis Centers, Freestanding Ambulatory Surgical and Emergency 

Centers, and all Other Outpatient Care Centers). 


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6 2005 NCPA-Pfizer Digest: Total, Prescription Sales Increase At Nation’s Independent Pharmacies. National Community Pharmacies Association Press Release, May 12, 2005. 7 Dental Education At-A-Glance, 2004. American Dental Education Association. Available at: http://www.adea.org/CEPR/Documents/2004

_Dental_Ed_At_A_Glance.pdf. 8 National Center for Health Workforce Analysis: U.S. Health Workforce Personnel Factbook. U.S. Dept. of Health and Human Services, Health 

Resources and Services Administration. 9 Number of Accredited Programs by Academic Year (7/1/2007—6/30/2008). Accreditation Council for Graduate Medical Education. Available 

at: 

http://www.acgme.org/adspublic/reports/accredited_programs.asp. 10 U.S. Department of Labor, Bureau of Labor Statistics, National Occupational Employment and Wage Estimates, May 2007. 11 HHS Grants Statistics, 2007. Available at 

http://www.hhs.gov/grantsnet. 12General Services Administration (estimated). 

The Department envisions three subcategories of potential costs for 

recipients and sub-recipients of 

Department funds: (1) Direct costs 

associated with the act of certification; 

(2) direct costs associated with 

collecting and maintaining certifications 

made by sub-recipients, and (3) indirect 

costs associated with certification. 

The direct cost of certification is the 

cost of reviewing the certification 

language, reviewing relevant entity 

policies and procedures, and reviewing 

files before signing. We estimate that 

each of the 584,294 entities will spend 

an average of 30 minutes on these 

activities. Although some entities may 

need to sign a certification statement 

more than once, we assume that the 

entity will only carefully review the 

language, procedures and their files 

before signing the initial statement each 

year. We assume the cost of signing 

subsequent statements to be small. 

Some existing HHS certification forms 

specify the certification statement 

should be signed by the CEO, CFO, 

direct owner, or Chairman of the Board. 

According to Bureau of Labor Statistics 

wage data, the mean hourly wage for 

occupation code 11–1011, Chief 

Executives, is $72.77. We estimate the 

loaded rate to be $145.54. Thus, 

assuming that the recipient chooses to 

have a high-level employee such as a 

Chief Executive certify on its behalf, the 

cost associated with the act of 

certification is $42.5 million (584,294 × 

.5 × $145.54). 

The direct cost of collecting and 

maintaining certifications made by subrecipients is estimated as the labor cost. 

We assume that each of the 73,088 grant 

awards and 4,245 contractors doing 

business with HHS have at least one 

sub-recipient. We also assume that, on 

average, each grant awardee and 

contractor will spend one hour 

collecting and maintaining certifications 

made by sub-recipients. The mean 

hourly wage for office and 

administrative support occupations, 

occupation code 43–0000, is $15.00, or 

$30 loaded. Thus, the cost of collecting 

and maintaining records is estimated to 

be $2 million (77,333 entities × 1 hour 

× $30). 

Indirect costs associated with the 

certification requirement might include 

costs for such actions as staffing/ 

scheduling changes and internal 

reviews to assess compliance. There is 

insufficient data to estimate the number 

of funding recipients not currently 

compliant with the Church 

Amendments, PHS Act § 245, or the 

Weldon Amendment. However, because 

together these three federal statutes have 

been in existence for many years, we 

expect the incremental and indirect 

costs of certification to be minimal for 

Department funding recipients. We 

specifically request comment on this 

assumption. 

The total quantifiable costs of the 

proposed regulation, if finalized, are 

estimated to be $44.5 million each year. 

Regulatory Flexibility Act 

HHS has examined the economic 

implications of this proposed rule as 

required by the Regulatory Flexibility 

Act (5 U.S.C. 601–612). If a rule has a 

significant economic impact on a 

substantial number of small entities, the 

Regulatory Flexibility Act (RFA) 

requires agencies to analyze regulatory 

options that would lessen the economic 

effect of the rule on small entities. For 

purposes of the RFA, small entities 

include small businesses, nonprofit 

organizations, and small governmental 

jurisdictions. Most hospitals and most 

other providers and suppliers are small 

entities, by virtue of either nonprofit 

status or having revenues of $6 million 

to $29 million in any 1 year. Individuals 

and States are not included in the 

definition of a small entity. While the 

proposed rule will affect a number of 

small entities, we preliminarily 

conclude that the costs of compliance 

are not economically significant (see 

discussion above). Moreover, in 

accordance with subsection 88.5(e) 

below, physicians, physician offices, 

and other health care practitioners 

participating in Medicare Part B or who 

are sub-recipients assisting in the 

implementation of a State Medicaid 

program are not subject to the written 

certification requirement. Thus, we 

conclude that this proposal, if finalized, 

will not impose significant costs on 

small entities. Therefore, the Secretary 

certifies that this rule will not result in 

a significant impact on a substantial 

number of small entities. 

Executive Order 13132—Federalism 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it promulgates a 

proposed rule (and subsequent final 

rule) that imposes substantial direct 

requirement costs on State and local 

governments, preempts State law, or 

otherwise has federalism implications. 

All three acts enforced in this 

proposed regulation—the Church 

Amendments, PHS Act § 245, and the 

Weldon Amendment—impose 

restrictions on States, local 

governments, and public entities 

receiving funds from the Department, 

including under certain Departmentimplemented statutes. Insofar as these 

regulations impact State and local 

governments, they do so only to the 

extent that States and local governments 

would be required to submit 

certifications of compliance with the 

statutes and these regulations, as 

applicable. Since we expect the 

recipients of Department funds to 

comply with existing federal law, we 

anticipate the impact on States and local 

governments of the proposed 

certification requirement to be 

negligible. 

The Department will consult with 

States and local governments to seek 

ways to minimize any burden imposed 

on the States and local governments by 

these proposed regulations, consistent 

with meeting the Department’s 

objectives of ensuring: (1) Knowledge of 

the obligations imposed, and the rights 

and protections afforded, by these 

federal nondiscrimination provisions; 

and (2) compliance with the 

nondiscrimination provisions. 

Unfunded Mandates Reform Act of 1995 

Title II of the Unfunded Mandates 

Reform Act of 1995 (Pub. L. 104–4) 

requires cost-benefit and other analyses 

before any rulemaking if the rule would 


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50282 Federal Register / Vol. 73, No. 166 / Tuesday, August 26, 2008 / Proposed Rules 

include a ‘‘Federal mandate that may 

result in the expenditure by State, local, 

and tribal governments, in the aggregate, 

or by the private sector, of $100,000,000 

or more (adjusted annually for inflation) 

in any 1 year.’’ The current inflationadjusted statutory threshold is 

approximately $130 million. The 

Department has determined that this 

proposed rule would not constitute a 

significant rule under the Unfunded 

Mandates Reform Act. 

Assessment of Federal Regulation and 

Policies on Families 

Section 654 of the Treasury and 

General Government Appropriations 

Act of 1999 requires federal 

departments and agencies to determine 

whether a proposed policy or regulation 

could affect family well-being. If the 

determination is affirmative, then the 

Department or agency must prepare an 

impact assessment to address criteria 

specified in the law. These regulations 

will not have an impact on family wellbeing, as defined in the Act. 

Paperwork Reduction Act of 1995 

This proposed rule does not create 

any new requirements under the 

Paperwork Reduction Act of 1995. 

List of Subjects in 45 CFR Part 88 

Abortion, Civil rights, Colleges and 

universities, Employment, Government 

contracts, Government employees, Grant 

programs, Grants administration, Health 

care, Health insurance, Health 

professions, Hospitals, Insurance 

companies, Laboratories, Medicaid, 

Medical and dental schools, Medical 

research, Medicare, Mental health 

programs, Nursing homes, Public 

health, Religious discrimination, 

Religious liberties, Reporting and 

recordkeeping requirements, Rights of 

conscience, Scientists, State and local 

governments, Sterilization, Students. 

Therefore, under the Church 

Amendments, 42 U.S.C. 300a–7, Public 

Health Service Act § 245, 42 U.S.C. 

238n, and the Weldon Amendment, 

Consolidated Appropriations Act, 2008, 

Pub. L. No. 110–161, Div. G, § 508(d), 

121 Stat. 1844, 2209, the Department of 

Health and Human Services proposes to 

add 45 CFR Part 88 to read as follows: 

PART 88—ENSURING THAT 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES FUNDS DO NOT 

SUPPORT COERCIVE OR 

DISCRIMINATORY POLICIES OR 

PRACTICES 

Sec. 

88.1 Purpose. 

88.2 Definitions. 

88.3 Applicability. 

88.4 Requirements and prohibitions. 

88.5 Written certification of compliance. 

Authority: 42 U.S.C. 300a–7, 42 U.S.C. 

238n, Pub. L. 120–161, Div. G, section 508(d), 

121 Stat. 1884, 2209, 31 U.S.C. 6306, 41 

U.S.C. 253, 40 U.S.C. 471, 42 U.S.C. 1395w–

22(j)(3)(B), and 42 U.S.C. 1396u–2(b)(3). 

§ 88.1 Purpose. 

The purpose of this part is to provide 

for the implementation and enforcement 

of the Church Amendments, 42 U.S.C. 

300a–7, section 245 of the Public Health 

Service Act, 42 U.S.C. 238n, and the 

Weldon Amendment, Consolidated 

Appropriations Act, 2008, Public Law 

No. 110–161, Div. G, section 508(d), 121 

Stat. 1844, 2209. These statutory 

provisions protect the rights of health 

care entities/entities, both individuals 

and institutions, to refuse to perform 

health care services to which they may 

object for religious, moral, ethical, or 

other reasons. Consistent with this 

objective to protect the conscience 

rights of health care entities/entities, the 

provisions in the Church Amendments, 

section 245 of the Public Health Service 

Act and the Weldon Amendment, and 

the implementing regulations contained 

in this Part are to be interpreted and 

implemented broadly to effectuate their 

protective purposes. 

§ 88.2 Definitions 

For the purposes of this part: 

Assist in the Performance means to 

participate in any activity with a 

reasonable connection to a procedure, 

health service or health service program, 

or research activity, so long as the 

individual involved is a part of the 

workforce of a Department-funded 

entity. This includes counseling, 

referral, training, and other 

arrangements for the procedure, health 

service, or research activity. 

Entity includes an individual 

physician or other health care 

professional, health care personnel, a 

participant in a program of training in 

the health professions, an applicant for 

training or study, a post graduate 

physician training program, a hospital, 

a provider-sponsored organization, a 

health maintenance organization, a 

health insurance plan, laboratory or any 

other kind of health care organization or 

facility. It may also include components 

of State or local governments. 

Health Care Entity includes an 

individual physician or other health 

care professional, health care personnel, 

a participant in a program of training in 

the health professions, an applicant for 

training or study in the health 

professions, a post graduate physician 

training program, a hospital, a providersponsored organization, a health 

maintenance organization, a health 

insurance plan, laboratory or any other 

kind of health care organization or 

facility. It may also include components 

of State or local governments. 

Health Service/Health Service 

Program includes any plan or program 

that provides health benefits, whether 

directly, through insurance, or 

otherwise, which is funded, in whole or 

in part, by the Department. It may also 

include components of State or local 

governments. 

Individual means a member of the 

workforce of an entity/health care 

entity. 

Instrument is the means by which 

federal funds are conveyed to a 

recipient, and includes grants, 

cooperative agreements, contracts, 

grants under a contract, memoranda of 

understanding, and any other funding or 

employment instrument or contract. 

Recipient means an organization or 

individual receiving funds directly from 

the Department or component of the 

Department to carry out a project or 

program. The term includes State and 

local governments, public and private 

institutions of higher education, public 

and private hospitals, commercial 

organizations, and other quasi-public 

and private nonprofit organizations 

such as, but not limited to, community 

action agencies, research institutes, 

educational associations, and health 

centers. The term may include foreign 

or international organizations (such as 

agencies of the United Nations) which 

are recipients, sub-recipients, or 

contractors or subcontractors of 

recipients or sub-recipients at the 

discretion of the Department awarding 

agency. 

Sub-recipient means an organization 

or individual receiving funds indirectly 

from the Department or component of 

the Department through a recipient or 

another sub-recipient to carry out a 

project or program. The term includes 

State and local governments, public and 

private institutions of higher education, 

public and private hospitals, 

commercial organizations, and other 

quasi-public and private nonprofit 

organizations such as, but not limited 

to, community action agencies, research 

institutes, educational associations, and 

health centers. The term may include 

foreign or international organizations 

(such as agencies of the United Nations) 

which are recipients, sub-recipients, or 

contractors or subcontractors of 

recipients or sub-recipients at the 

discretion of the Department awarding 

agency. 

Workforce includes employees, 

volunteers, trainees, and other persons 

whose conduct, in the performance of 


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work for a Department-funded entity, is 

under the control or authority of such 

entity, whether or not they are paid by 

the Department-funded entity. 

§ 88.3 Applicability. 

(a) The Department of Health and 

Human Services is required to comply 

with § 88.4(a), (b)(1), and (d)(1). 

(b) Any State or local government that 

receives federal funds appropriated 

through the appropriations act for the 

Department of Health and Human 

Services is required to comply with 

§§ 88.4(b)(1) and 88.5. 

(c) Any entity that receives federal 

funds appropriated through the 

appropriations act for the Department of 

Health and Human Services to 

implement any part of any federal 

program is required to comply with 

§§ 88.4(b)(2) and 88.5. 

(d) Any State or local government that 

receives federal financial assistance is 

required to comply with §§ 88.4(a) and 

88.5. 

(e) Any State or local government, any 

part of any State or local government, or 

any other public entity must comply 

with § 88.4(e). 

(f)(1) Any entity, including a State or 

local government, that receives a grant, 

contract, loan, or loan guarantee under 

the Public Health Service Act, the 

Community Mental Health Centers Act, 

or the Developmental Disabilities 

Assistance and Bill of Rights Act of 

2000, must comply with §§ 88.4(c)(1) 

and 88.5. 

(2) In addition to complying with the 

provisions set forth in § 88.4(c)(1), any 

such entity that is an educational 

institution, teaching hospital, or 

program for the training of health care 

professionals or health care workers 

shall also comply with § 88.4(a)(2). 

(g)(1) Any entity, including a State or 

local government, that carries out any 

part of any health service program or 

research activity funded in whole or in 

part under a program administered by 

the Secretary of Health and Human 

Services must comply with §§ 88.4(d)(1) 

and 88.5. 

(2) In addition to complying with the 

provisions set forth in paragraph (g)(1) 

of this section, any such entity that 

receives grants or contracts for 

biomedical or behavioral research under 

any program administered by the 

Secretary of Health and Human Services 

shall also comply with § 88.4(d)(2). 

§ 88.4 Requirements and prohibitions. 

(a) Entities to whom this paragraph (a) 

applies shall not: 

(1) Subject any institutional or 

individual health care entity to 

discrimination for refusing: 

(i) To undergo training in the 

performance of abortions, or to require, 

provide, refer for, or make arrangements 

for training in the performance of 

abortions; 

(ii) To perform, refer for, or make 

other arrangements for, abortions; or 

(iii) To refer for abortions; 

(2) Subject any institutional or 

individual health care entity to 

discrimination for attending or having 

attended a post-graduate physician 

training program, or any other program 

of training in the health professions, 

that does not or did not require 

attendees to perform induced abortions 

or require, provide, or refer for training 

in the performance of induced 

abortions, or make arrangements for the 

provision of such training; 

(3) For the purposes of granting a legal 

status to a health care entity (including 

a license or certificate), or providing 

such entity with financial assistance, 

services or benefits, fail to deem 

accredited any postgraduate physician 

training program that would be 

accredited but for the accrediting 

agency’s reliance upon an accreditation 

standard or standards that require an 

entity to perform an induced abortion or 

require, provide, or refer for training in 

the performance of induced abortions, 

or make arrangements for such training, 

regardless of whether such standard 

provides exceptions or exemptions; 

(b)(1) Any entity to whom this 

paragraph (b)(1) applies shall not 

subject any institutional or individual 

health care entity to discrimination on 

the basis that the health care entity does 

not provide, pay for, provide coverage 

of, or refer for, abortion. 

(2) Entities to whom this paragraph 

(b)(2) applies shall not subject any 

institutional or individual health care 

entity to discrimination on the basis that 

the health care entity does not provide, 

pay for, provide coverage of, or refer for 

abortion as part of the federal program 

for which it receives funding. 

(c) Entities to whom this paragraph (c) 

applies shall not: 

(1) Discriminate against any physician 

or other health care professional in the 

employment, promotion, termination, or 

extension of staff or other privileges 

because he performed or assisted in the 

performance, or refused to perform or 

assist in the performance of a lawful 

sterilization procedure or abortion on 

the grounds that doing so would be 

contrary to his religious beliefs or moral 

convictions, or because of his religious 

beliefs or moral convictions concerning 

abortions or sterilization procedures 

themselves; 

(2) Discriminate against or deny 

admission to any applicant for training 

or study because of reluctance or 

willingness to counsel, suggest, 

recommend, assist, or in any way 

participate in the performance of 

abortions or sterilizations contrary to or 

consistent with the applicant’s religious 

beliefs or moral convictions. 

(d) Entities to whom this paragraph 

(d) applies shall not: 

(1) Require any individual to perform 

or assist in the performance of any part 

of a health service program or research 

activity funded by the Department if 

such service or activity would be 

contrary to his religious beliefs or moral 

convictions. 

(2) Discriminate in the employment, 

promotion, termination, or the 

extension of staff or other privileges to 

any physician or other health care 

personnel because he performed, 

assisted in the performance, refused to 

perform, or refused to assist in the 

performance of any lawful health 

service or research activity on the 

grounds that his performance or 

assistance in performance of such 

service or activity would be contrary to 

his religious beliefs or moral 

convictions, or because of the religious 

beliefs or moral convictions concerning 

such activity themselves. 

(e) Entities to whom this paragraph (e) 

applies shall not, on the basis that the 

individual or entity has received a grant, 

contract, loan, or loan guarantee under 

the Public Health Service Act, the 

Community Mental Health Centers Act, 

or the Developmental Disabilities 

Assistance and Bill of Rights Act of 

2000, require: 

(1) Such individual to perform or 

assist in the performance of any 

sterilization procedure or abortion if his 

performance or assistance in the 

performance of such procedure or 

abortion would be contrary to his 

religious beliefs or moral convictions, or 

(2) Such entity to: 

(i) Make its facilities available for the 

performance of any sterilization 

procedure or abortion if the 

performance of such procedure or 

abortion in such facilities is prohibited 

by the entity on the basis of religious 

beliefs or moral convictions, or 

(ii) Provide any personnel for the 

performance or assistance in the 

performance of any sterilization 

procedure or abortion if the 

performance or assistance in the 

performance of such procedure or 

abortion by such personnel would be 

contrary to the religious beliefs or moral 

convictions of such personnel. 

§ 88.5 Written certification of compliance. 

(a) Certification requirement. Except 

as provided in paragraph (e) of this 


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50284 Federal Register / Vol. 73, No. 166 / Tuesday, August 26, 2008 / Proposed Rules 

section, recipients shall include the 

written certifications as set forth in 

paragraph (c)(4) of this section in the 

application for the grant, cooperative 

agreement, contract, grant under a 

contract, memorandum of 

understanding or other funding or 

employment instrument or contract, as 

applicable. Except as provided in 

paragraph (e) of this section, subrecipients must provide the Certification 

of Compliance as set out in paragraph 

(d)(3) of this section, submitted as part 

of its original agreement with the 

recipient in the execution of its grant, 

cooperative agreement, contract, grant 

under a contract, memorandum of 

understanding or other funding 

instrument, or in a separate writing, 

signed by the sub-recipients’ officer or 

other person authorized to bind the subrecipient. Certifications shall be made 

by an officer or other individual 

authorized to bind the recipient or subrecipient. All certifications shall be 

addressed directly to the Department; 

recipients are required to submit their 

certifications directly to the Department. 

Recipients shall be in full compliance 

with all applicable certification 

requirements by no later than the 

beginning of the federal fiscal year 

following the effective date of this 

regulation. 

(b) Notification of certification 

requirement. The Department shall 

notify recipients of funding of the 

certification requirement at the time of 

award through the Request for Proposal, 

Request for Agreement, Provider 

Agreement, contract, guidance, or other 

public announcement of the availability 

of funding. Recipients shall not construe 

anything in this paragraph to mean that 

an entity or organization is in any way 

exempt from providing the certification 

in the event the Department should fail 

to provide notification. 

(c) Certification by recipients. 

(1) Except as provided in paragraph 

(e) of this section, all recipients through 

any instrument must provide the 

Certification of Compliance as set out in 

paragraph (c)(4) of this section, 

submitted as part of the recipient’s 

application for the grant, cooperative 

agreement, contract, grant under a 

contract, memorandum of 

understanding or other funding 

instrument or in a separate writing 

signed by the recipients’ officer or other 

person authorized to bind the recipient. 

(2) Recipients must file with the 

Department a renewed certification 

upon any renewal, extension, 

amendment, or modification of the 

grant, cooperative agreement, contract, 

grant under a contract, memorandum of 

understanding or other funding or 

employment instrument or contract that 

extends the term of such instrument or 

adds additional funds to it. Recipients 

that are already recipients as of the 

effective date of this regulation must file 

a certification upon any extension, 

amendment, or modification of the 

grant, cooperative agreement, contract, 

grant under a contract, memorandum of 

understanding or other funding 

instrument that extends the term of such 

instrument or adds additional funds to 

it. 

(3) Recipients shall require 

certifications and re-certifications by all 

sub-recipients that receive funding 

through their association with the 

recipient. Recipients shall require these 

certifications and re-certifications as 

often as recipients are required to sign 

or amend the instrument, for as long as 

the relationship between the recipient 

and the sub-recipient lasts. Recipients 

shall collect and maintain sub-recipient 

certifications for as long as the 

relationship between the recipient and 

the sub-recipient lasts, and for a 

reasonable time after the relationship 

ends, for the purpose of investigations, 

litigation, or other purposes. 

(4) The certification. Except as 

provided in paragraph (e) of this 

section, all recipients shall provide the 

following certification: 

As the duly authorized representative of 

the recipient I certify that the recipient of 

funds made available through this 

[instrument] will not discriminate on the 

basis of an entity’s past involvement in, or 

refusal to assist in the performance of, the 

practices of abortion or sterilization, and will 

not require involvement in procedures that 

violate an individual’s conscience as part of 

any part of any health service program, in 

accord with all applicable sections of 45 CFR 

part 88. 

I further certify that the recipient 

acknowledges that any violation of these 

certifications shall be grounds for 

termination by the Department of any grant, 

cooperative agreement, contract, grant under 

a contract, memorandum of understanding or 

other funding or employment instrument or 

contract prior to the end of its term and 

recovery of appropriated funds expended 

prior to termination. I further certify that, 

except as provided in 45 CFR 88.5(e), the 

recipient will include this certification 

requirement in any [instrument] to a subrecipient of funds made available under this 

instrument, and will require, except as 

provided in 45 CFR 88.5(e), such subrecipient to provide the same certification 

that the recipient organization or entity 

provided. I further certify the recipient 

organization will collect and maintain subrecipient certifications for as long as the 

relationship between the recipient and the 

sub-recipient lasts, and for a reasonable time 

after the relationship ends, for the purpose of 

investigations, litigation, or other purposes. 

(d) Certification by sub-recipients. 

(1) Except as provided in paragraph 

(e) of this section, organizations or 

entities that are sub-recipients of the 

organization or entity providing the 

initial Certification of Compliance must 

submit to the recipient for maintenance 

by the recipient through which the subrecipient receives Department funds 

Certification of Compliance as set out in 

paragraph (d)(3) of this section, as part 

of the grant, cooperative agreement, 

contract, grant under a contract, 

memorandum of understanding or other 

funding instrument between the 

recipient and the sub-recipient or in a 

separate writing signed by the subrecipients’ officer or other person 

authorized to bind the sub-recipient. 

(2) Except as provided in paragraph 

(e) of this section, sub-recipients of 

funds shall renew certification to the 

recipient through which it receives 

Department funds upon any renewal, 

extension, amendment, or modification 

of the grant, cooperative agreement, 

contract, grant under a contract, 

memorandum of understanding or other 

funding or employment instrument or 

contract that extends the term of such 

instrument or adds additional funds to 

it. Sub-recipients shall submit such 

renewals to the recipient entities 

through which they receive Department 

funding. Entities that are already subrecipients as of the effective date of this 

regulation must certify upon any 

extension, amendment, or modification 

of the grant, cooperative agreement, 

contract, grant under a contract, 

memorandum of understanding or other 

funding instrument that extends the 

term of such instrument or adds 

additional funds to it, and shall submit 

such certifications to the recipient entity 

through which they receive Department 

funding. 

(3) The certification. Except as 

provided in paragraph (e) of this 

section, all sub-recipients of Department 

funds shall provide the following 

certification: 

As the duly authorized representative of 

the sub-recipient I certify that the subrecipient of funds made available through 

this [instrument] will not discriminate on the 

basis of an entity’s past involvement in, or 

refusal to assist in the performance of, the 

practices of abortion or sterilization, and will 

not require involvement in procedures that 

violate an individual’s conscience as part of 

any part of any health service program, in 

accord with all applicable sections of 45 CFR 

part 88. 

I further certify that the sub-recipient 

acknowledges that these certifications by the 

sub-recipient of funds are certifications made 

directly to the Department and that any 

violation of these certifications shall be 

grounds for termination by the Department of 

the recipient’s grant, cooperative agreement, 


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Federal Register / Vol. 73, No. 166 / Tuesday, August 26, 2008 / Proposed Rules 50285 

1See 47 CFR 1.1206(b)(2). 

contract, grant under a contract, 

memorandum of understanding or other 

funding or employment instrument or 

contract prior to the end of its term and 

recovery of appropriated funds expended 

prior to termination. I further certify that the 

sub-recipient will submit all certifications to 

the recipient entity through which it received 

Department funds. 

(e) Exceptions. Provided that such 

individuals or organizations are not 

recipients or sub-recipients of 

Department funds through another 

instrument, program, or mechanism, 

other than those set forth in paragraphs 

(e)(1) through (3) of this section, the 

following individuals or organizations 

shall not be required to comply with the 

written certification requirement set 

forth in this section: 

(1) A physician, as defined in 42 

U.S.C. 1395(r), physician office, or other 

health care practitioner participating in 

Part B of the Medicare program; 

(2) A physician, as defined in 42 

U.S.C. 1395(r), physician office, or other 

health care practitioner which 

participates in Part B of the Medicare 

program, when such individuals or 

organizations are sub-recipients of 

Department funds through a Medicare 

Advantage plan; or 

(3) A sub-recipient of Department 

funds through a State Medicaid 

program. 

Dated: August 20, 2008. 

Michael O. Leavitt, 

Secretary. 

[FR Doc. E8–19744 Filed 8–21–08; 2:00 pm] 

BILLING CODE 4150–28–P 

FEDERAL COMMUNICATIONS 

COMMISSION 

47 CFR Part 1 

[MD Docket No. 08–65; FCC 08–182] 

Assessment and Collection of 

Regulatory Fees for Fiscal Year 2008 

AGENCY: Federal Communications 

Commission. 

ACTION: Proposed rule. 

SUMMARY: In this document, we seek 

comment on changes to the regulatory 

fee schedule and methodology. 

DATES: Comments are due September 

25, 2008, and reply comments are due 

October 27, 2008. 

ADDRESSES: You may submit comments, 

identified by MD Docket No. 08–65, by 

any of the following methods: 

• Federal eRulemaking Portal: http:// 

www.regulations.gov. Follow the 

instructions for submitting comments. 

• Federal Communications 

Commission’s Web Site: http:// 

www.fcc.gov/cgb/ecfs. Follow the 

instructions for submitting comments. 

• E-mail: ecfs@fcc.gov. Include MD 

Docket No. 08–65 in the subject line of 

the message. 

• Mail: Commercial overnight mail 

(other than U.S. Postal Service Express 

Mail, and Priority Mail, must be sent to 

9300 East Hampton Drive, Capitol 

Heights, MD 20743. U.S. Postal Service 

first-class, Express, and Priority mail 

should be addressed to 445 12th Street, 

SW., Washington, DC 20554. 

• People with Disabilities: Contact the 

FCC to request reasonable 

accommodations (accessible format 

documents, sign language interpreters, 

CART, etc.) by email: FCC504@fcc.gov 

or phone: (202) 418–0530 or TTY (202) 

418–0432. 

FOR FURTHER INFORMATION CONTACT: 

CORES Helpdesk at (877) 480–3201, 

option 4 or ARINQUIRIES@fcc.gov. 

SUPPLEMENTARY INFORMATION: This is a 

summary of the Commission’s Further 

Notice of Proposed Rulemaking, MD 

Docket No. 08–65, FCC 08–182 adopted 

on August 1, 2008 and released on 

August 8, 2008. The full text of this 

document is available is available for 

inspection and copying during normal 

business hours in the FCC Reference 

Center (Room CY–A257), 445 12th 

Street, SW., Washington, DC 20554. The 

complete text of this document also may 

be purchased from the Commission’s 

copy contractor, Best Copy and Printing, 

Inc., 445 12th Street, SW., Room CY–

B402, Washington, DC 20554. The full 

text may also be downloaded at http:// 

www.fcc.gov. 

Pursuant to sections 1.1206(b), 1.1202 

and 1.1203 of the Commission’s rules, 

CFR 1.1206(b), 1.1202, 1.1203, this is as 

a ‘‘permit-but-disclose’’ proceeding. Ex 

parte presentations are permissible if 

disclosed in accordance with 

Commission rules, except during the 

Sunshine Agenda period when 

presentations, ex parte or otherwise, are 

generally prohibited. Persons making 

oral ex parte presentations are reminded 

that a memorandum summarizing a 

presentation must contain a summary of 

the substance of the presentation and 

not merely a listing of the subjects 

discussed. More than a one- or twosentence description of the views and 

arguments presented is generally 

required.1 Additional rules pertaining to 

oral and written presentations are set 

forth in section 1.1206(b). 

Pursuant to sections 1.415 and 1.419 

of the Commission’s rules, 47 CFR 

1.415, 1.419, interested parties may file 

comments on or before the dates 

indicated on the first page of this 

document. Comments may be filed 

using: (1) The Commission’s Electronic 

Comment Filing System (‘‘ECFS’’), (2) 

the Federal Government’s eRulemaking 

Portal, or (3) procedures for filing paper 

copies. See Electronic Filing of 

Documents in Rulemaking Proceedings, 

63 FR 24121 (1998), 13 FCC Rcd 11322 

(1998). 

• Electronic Filers: Comments may be 

filed electronically using the Internet by 

accessing the ECFS: http://www.fcc.gov/ 

cgb/ecfs or the Federal eRulemaking 

Portal: http://www.regulations.gov. 

Filers should follow the instructions 

provided on the Web site for submitting 

comments. For ECFS filers, if multiple 

docket or rulemaking numbers appear in 

the caption of this proceeding, filers 

must transmit one electronic copy of the 

comments for each docket or 

rulemaking number referenced in the 

caption. In completing the transmittal 

screen, filers should include their full 

name, U.S. Postal Service mailing 

address, and the applicable docket or 

rulemaking number. Parties may also 

submit an electronic comment by 

Internet e-mail. To get filing 

instructions, filers should send an email to ecfs@fcc.gov, and include the 

following words in the body of the 

message, ‘‘get form.’’ A sample form and 

directions will be sent in response. 

• Paper Filers: Parties who choose to 

file by paper must file an original and 

four copies of each filing. If more than 

one docket or rulemaking number 

appears in the caption of this 

proceeding, filers must submit two 

additional copies for each additional 

docket or rulemaking number. Filings 

can be sent by hand or messenger 

delivery, by commercial overnight 

courier, or by first-class or overnight 

U.S. Postal Service mail (although we 

continue to experience delays in 

receiving U.S. Postal Service mail). All 

filings must be addressed to the 

Commission’s Secretary, Office of the 

Secretary, Federal Communications 

Commission. 

• The Commission’s contractor will 

receive hand-delivered or messengerdelivered paper filings for the 

Commission’s Secretary at 236 

Massachusetts Avenue, NE., Suite 110, 

Washington, DC 20002. The filing hours 

at this location are 8 a.m. to 7 p.m. All 

hand deliveries must be held together 

with rubber bands or fasteners. Any 

envelopes must be disposed of before 

entering the building. 

• Commercial overnight mail (other 

than U.S. Postal Service Express Mail 

and Priority Mail) must be sent to 9300 

East Hampton Drive, Capitol Heights, 

MD 20743. 


sroberts on PROD1PC76 with PROPOSALS