Federal Register / Vol. 82, No. 159 / Friday, August 18, 2017 / Notices 39439 

1 Garrison LE, Kunz JM, Cooley LA, et al. Vital 

signs: Deficiencies in environmental control 

identified in outbreaks of Legionnaires disease— 

North America, 2000–2014. MMWR Morb Mortal 

Wkly Rep 2016; 65:576–84. https://doi.org/ 

10.15585/mmwr.mm6522e1. 

2ASHRAE 188: Legionellosis: Risk Management 

for Building Water Systems June 26, 2015. 

ASHRAE: Atlanta. www.ashrae.org. 

ESTIMATED ANNUALIZED BURDEN HOURS

Type of respondents Form name Number of 

respondents 

Number of 

responses per 

respondent 

Avg. burden 

per response 

(in hours) 

Total burden 

(in hours) 

Women with recent births .................. Maternal hospital-based questionnaire.2,990 1 25/60 1,247 

Fathers with recently born infants ..... Father hospital-based questionnaire 1,790 1 15/60 448 

Women with live births 2–10 months 

prior.

Follow-up phone questionnaire ......... 3,070 1 15/60 768 

Total ............................................ ............................................................ ...................... ........................ ........................ 2,463 

Leroy A. Richardson, 

Chief, Information Collection Review Office, 

Office of Scientific Integrity, Office of the 

Associate Director for Science, Office of the 

Director, Centers for Disease Control and 

Prevention. 

[FR Doc. 2017–17518 Filed 8–17–17; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

[Docket No. CDC–2017–0069] 

Effective Methods for Implementing 

Water Management Programs (WMPs) 

To Reduce Growth of Transmission of 

Legionella spp. 

AGENCY: Centers for Disease Control and 

Prevention (CDC), Department of Health 

and Human Services (HHS). 

ACTION: Request for information. 

SUMMARY: The Centers for Disease 

Control and Prevention (CDC) in the 

Department of Health and Human 

Services (HHS) announces the opening 

of a docket to obtain information on 

effective methods for achieving 

implementation of water management 

programs (WMPs) intended to reduce 

Legionella growth and transmission in 

buildings at increased risk. The 

information will inform CDC efforts to 

prevent Legionnaires disease in the 

United States. Information gathered 

should also inform CDC efforts to 

prevent disease due to other 

opportunistic waterborne pathogens 

(e.g., Pseudomonas, Acinetobacter, 

Burkholderia, Stenotrophomonas, 

nontuberculous mycobacteria, various 

species of fungi, and Naegleria). 

DATES: Written comments must be 

received on or before October 17, 2017. 

ADDRESSES: You may submit comments, 

identified by Docket No. CDC–2017– 

0069 by any of the following methods: 

• Federal eRulemaking Portal: http:// 

www.regulations.gov. Follow the 

instructions for submitting comments. 

• Mail: Laura Cooley, National Center 

for Immunization and Respiratory 

Diseases, Division of Bacterial Diseases, 

Centers for Disease Control and 

Prevention, 1600 Clifton Road NE., MS 

C25, Atlanta, GA 30329. 

Instructions: All submissions received 

must include the agency name and 

Docket Number. All relevant comments 

received will be posted without change 

to http://regulations.gov, including any 

personal information provided. For 

access to the docket to read background 

documents or comments received, go to 

http://www.regulations.gov. 

FOR FURTHER INFORMATION CONTACT: 

Laura Cooley, National Center for 

Immunization and Respiratory Diseases, 

Division of Bacterial Diseases, Centers 

for Disease Control and Prevention, 

1600 Clifton Road NE., MS C25, Atlanta, 

GA 30329. Email: 

travellegionella@cdc.gov. Phone: (404) 

639–2215. 

SUPPLEMENTARY INFORMATION: 

Background: CDC assists state and 

local health departments with 

Legionnaires disease response and 

prevention efforts by providing 

technical assistance and developing 

resources focused on preventing and 

investigating cases and outbreaks of 

Legionnaires disease (https:// 

www.cdc.gov/legionella/). 

Legionnaires disease, a severe, 

sometimes fatal pneumonia, can occur 

in persons who inhale aerosolized 

droplets of water contaminated with the 

bacterium Legionella. The rate of 

reported cases of Legionnaires disease 

in the United States has increased more 

than four-fold since 2000.1 Legionella 

and other waterborne pathogens can 

multiply in large, complex building 

water systems where there are gaps in 

water system maintenance; thus, the 

most effective strategy for prevention of 

Legionnaires disease is through control 

of Legionella in building water systems. 

Water management programs (WMPs) 

identify hazardous conditions and take 

steps to minimize the growth and 

spread of Legionella and other 

waterborne pathogens in building water 

systems. Developing and maintaining a 

water management program is a multistep process that requires continuous 

review. 

In 2015, ASHRAE (formerly known as 

the American Society of Heating, 

Refrigerating, and Air-Conditioning 

Engineers) published a consensus 

standard for the primary prevention of 

Legionnaires disease,2 which calls for 

the development and implementation of 

WMPs in buildings with large or 

complex water systems and in buildings 

that house people who are particularly 

susceptible to Legionnaires disease. 

ASHRAE recommends WMPs for the 

following buildings and devices: 

• Healthcare facilities where patients 

stay overnight 

• Buildings that house or treat people 

who have chronic and acute medical 

problems or weakened immune 

systems 

• Buildings that primarily house people 

older than 65 years (like a retirement 

home or assisted living facility) 

• Buildings that have a centralized hot 

water system (like a hotel or high-rise 

apartment complex) 

• Buildings 10 stories or more 

(including basement levels) 

• Devices that have been linked to 

transmission of Legionella: 

Æ Cooling towers 

Æ Hot tubs (or spas) that are not 

drained between each use 

Æ Decorative fountains 

Æ Centrally-installed misters, 

atomizers, air washers, or 

humidifiers 

Additionally, stakeholders can use 

CDC’s toolkit, Developing a Water 

Management Program to Reduce 

Legionella Growth & Spread in 

Buildings: A Practical Guide to 

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39440 Federal Register / Vol. 82, No. 159 / Friday, August 18, 2017 / Notices 

3https://www.cdc.gov/legionella/downloads/

toolkit.pdf. 

Implementing Industry Standards.3 This 

toolkit is dedicated to developing and 

implementing WMPs and can inform 

conversations with building owners and 

managers on how to reduce the risk of 

Legionella growth and transmission in 

their building water systems. 

Information Needs 

While a consensus standard and 

guidance exist regarding development 

and implementation of WMPs, there are 

gaps regarding the most effective 

methods to encourage WMP 

implementation. A variety of 

stakeholders (e.g., public health 

partners, industry leaders, accreditation 

or licensing bodies) routinely work with 

building owners and managers on 

WMPs or on related policies. However, 

successful communication and 

implementation of WMPs can be 

challenging, and more information is 

needed on how implementation of 

WMPs can be improved. CDC seeks 

public comments in response to the 

following questions to guide best 

practices, especially regarding the 

dissemination and implementation of 

WMPs. The information gathered will 

be used to guide best practices regarding 

effective strategies to prevent 

Legionnaires disease in the United 

States. Information gathered can also 

inform efforts to prevent disease due to 

other waterborne pathogens. 

Please feel free to respond to any or 

all of the questions. Possible domains to 

consider in answering these questions 

include (but are not limited to): 

• Local knowledge about Legionnaires 

disease, Legionella growth, and 

prevention strategies 

• Stakeholder engagement (key 

supporters and opponents) 

• Feasibility of WMP implementation 

• Costs and benefits of WMP 

implementation 

• Availability of effective 

communication strategies 

• Possible impact of proposed solutions 

including unintended consequences 

such as degradation of plumbing 

infrastructure or pathogen 

substitution (e.g., remediation 

directed at one pathogen, such as 

Legionella, leading to increases in a 

second pathogen, such as 

nontuberculous mycobacteria) 

• Historical context in which a WMP 

was or was not adopted 

• Influence of local regulations 

Questions 

(1) What existing standards or 

guidance does your organization use for 

the prevention of Legionella growth and 

transmission? 

(2) Are there other standards or 

guidance for the prevention of 

Legionella growth and transmission that 

you would find useful but do not exist 

or are not currently available to you? If 

so, what information should those 

standards or guidance contain? 

(3) What is your organization’s role, 

and your role within the organization, 

in achieving implementation of WMPs 

by owners and managers of buildings at 

increased risk for Legionella growth and 

transmission? 

(4) In your organization’s experience, 

what are the principal barriers to 

implementation of WMPs by building 

owners and managers? 

(5) Where there are barriers, what has 

your organization done to overcome 

these barriers? 

(6) Where implementation of WMPs 

has gone smoothly, what factors (e.g., 

resources, guidance, activities) 

contributed to this success? 

(7) Has your organization had 

experience with approaches to WMP 

implementation that are specific to 

certain settings (e.g., hotels, hospitals) 

or devices (e.g., cooling towers, potable 

water)? If so, have you learned anything 

from these different approaches that 

could be used to improve WMP 

implementation? Have you looked for or 

experienced any unintended 

consequences related to a WMP? 

(8) A limited number of jurisdictions 

have implemented regulations to reduce 

the risk of Legionella growth and 

transmission (e.g., New York, New York 

City). In your state or local jurisdiction, 

should building codes or other types of 

public health regulation or legislation be 

used to help prevent Legionnaires’ 

disease? Why or why not? 

(9) Are there other approaches to 

reducing the risk of Legionnaires’ 

disease that your organization has found 

to be useful besides implementation of 

WMPs? 

(10) What additional considerations 

are relevant to developing guidance for 

preventing Legionnaires disease? 

(11) Has your organization 

implemented specific approaches to 

reducing the risk of disease due to other 

opportunistic waterborne pathogens 

besides Legionella? If so, please explain. 

Do these approaches conflict in any way 

with your approaches to reducing the 

risk of Legionnaires disease? 

Dated: August 15, 2017. 

Sandra Cashman, 

Executive Secretary, Centers for Disease 

Control and Prevention. 

[FR Doc. 2017–17491 Filed 8–17–17; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10437 and CMS– 

10652] 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, HHS. 

ACTION: Notice. 

SUMMARY: The Centers for Medicare & 

Medicaid Services (CMS) is announcing 

an opportunity for the public to 

comment on CMS’ intention to collect 

information from the public. Under the 

Paperwork Reduction Act of 1995 

(PRA), federal agencies are required to 

publish notice in the Federal Register 

concerning each proposed collection of 

information, including each proposed 

extension or reinstatement of an existing 

collection of information, and to allow 

a second opportunity for public 

comment on the notice. Interested 

persons are invited to send comments 

regarding the burden estimate or any 

other aspect of this collection of 

information, including the necessity and 

utility of the proposed information 

collection for the proper performance of 

the agency’s functions, the accuracy of 

the estimated burden, ways to enhance 

the quality, utility, and clarity of the 

information to be collected, and the use 

of automated collection techniques or 

other forms of information technology to 

minimize the information collection 

burden. 

DATES: Comments on the collection(s) of 

information must be received by the 

OMB desk officer by September 18, 

2017. 

ADDRESSES: When commenting on the 

proposed information collections, 

please reference the document identifier 

or OMB control number. To be assured 

consideration, comments and 

recommendations must be received by 

the OMB desk officer via one of the 

following transmissions: OMB, Office of 

Information and Regulatory Affairs, 

Attention: CMS Desk Officer, Fax 

Number: (202) 395–5806 OR, Email: 

OIRA_submission@omb.eop.gov. 

To obtain copies of a supporting 

statement and any related forms for the 

proposed collection(s) summarized in 

this notice, you may make your request 

using one of following: 

1. Access CMS’ Web site address at 

http://www.cms.hhs.gov/ 

PaperworkReductionActof1995. 

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