Agency Information Collection Activities: Proposed Collection: Comment Request, 15436-15437 [2010-6880]
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cprice-sewell on DSK89S0YB1PROD with NOTICES
15436
Federal Register / Vol. 75, No. 59 / Monday, March 29, 2010 / Notices
of Respondents: 56; Total Annual
Responses: 56; Total Annual Hours:
280. (For policy questions regarding this
collection contact Donna Schmidt at
410–786–5532. For all other issues call
410–786–1326.)
2. Type of Information Collection
Request: Reinstatement with change of a
previously approved collection; Title of
Information Collection: Business
Proposal Forms for Quality
Improvement Organizations (QIOs); Use:
The submission of proposal information
by current quality improvement
associations (QIOs) and other bidders,
on the appropriate forms, will satisfy
CMS’s need for meaningful, consistent,
and verifiable data with which to
evaluate contract proposals. The data
collected on the forms associated with
this information collection request is
used by CMS to negotiate QIO contracts.
The revised business proposal forms
will be useful in a number of important
ways. The Government will be able to
compare the costs reported by the QIOs
on the cost reports to the proposed costs
noted on the business proposal forms.
Subsequent contract and modification
negotiations will be based on historic
cost data. The business proposal forms
will be one element of the historical cost
data from which we can analyze future
proposed costs. In addition, the
business proposal format will
standardize the cost proposing and
pricing process among all QIOs. With
well-defined cost centers and line items,
proposals can be compared among QIOs
for reasonableness and appropriateness.
Form Number: CMS–718–721 (OMB#:
0938–0579); Frequency: Reporting—
Triennially; Affected Public: Business or
other for-profits and Not-for-profit
institutions; Number of Respondents:
21; Total Annual Responses: 21; Total
Annual Hours: 1,785. (For policy
questions regarding this collection
contact Clarissa Whatley at 410–786–
7154. For all other issues call 410–786–
1326.)
3. Type of Information Collection
Request: Reinstatement without change
of a previously approved collection;
Title of Information Collection: End
Stage Renal Disease (ESRD) Network
Semi-Annual Cost Report Forms and
Supporting Regulations in 42 CFR
405.2110 and 42 CFR 405.2112; Use:
Section 1881(c) of the Social Security
Act establishes End Stage Renal Disease
(ESRD) Network contracts. The
regulations found at 42 CFR 405.2110
and 405.2112 designated 18 ESRD
VerDate Nov<24>2008
09:18 Apr 05, 2010
Jkt 220001
Networks which are funded by
renewable contracts. These contracts are
on 3-year cycles. To better administer
the program, CMS is requiring
contractors to submit semi-annual cost
reports. The purpose of the cost reports
is to enable the ESRD Networks to
report costs in a standardized manner.
This will allow CMS to review, compare
and project ESRD Network costs during
the life of the contract. Form Number:
CMS–685 (OMB#: 0938–0657);
Frequency: Reporting—Semi-annually;
Affected Public: Not-for-profit
institutions; Number of Respondents:
18; Total Annual Responses: 36; Total
Annual Hours: 108. (For policy
questions regarding this collection
contact Victoria Morgan at 410–786–
7232. For all other issues call 410–786–
1326.)
To obtain copies of the supporting
statement and any related forms for the
proposed paperwork collections
referenced above, access CMS Web Site
address at https://www.cms.hhs.gov/
PaperworkReductionActof1995, or email your request, including your
address, phone number, OMB number,
and CMS document identifier, to
Paperwork@cms.hhs.gov, or call the
Reports Clearance Office on (410) 786–
1326.
To be assured consideration,
comments and recommendations for the
proposed information collections must
be received by the OMB desk officer at
the address below, no later than 5 p.m.
on April 28, 2010: OMB, Office of
Information and Regulatory Affairs,
Attention: CMS Desk Officer, Fax
Number: (202) 395–6974, E-mail:
OIRA_submission@omb.eop.gov.
Dated: March 19, 2010.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2010–7033 Filed 3–26–10; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Health Resources and Services
Administration
Agency Information Collection
Activities: Proposed Collection:
Comment Request
In compliance with the requirement
for opportunity for public comment on
proposed data collection projects
PO 00000
Frm 00036
Fmt 4703
Sfmt 4703
(section 3506(c)(2)(A) of Title 44, United
States Code, as amended by the
Paperwork Reduction Act of 1995, Pub.
L. 104–13), the Health Resources and
Services Administration (HRSA)
publishes periodic summaries of
proposed projects being developed for
submission to the Office of Management
and Budget (OMB) under the Paperwork
Reduction Act of 1995. To request more
information on the proposed project or
to obtain a copy of the data collection
plans and draft instruments, e-mail
paperwork@hrsa.gov or call the HRSA
Reports Clearance Officer at (301) 443–
1129.
Comments are invited on: (a) The
proposed collection of information for
the proper performance of the functions
of the agency; (b) the accuracy of the
agency’s estimate of the burden of the
proposed collection of information; (c)
ways to enhance the quality, utility, and
clarity of the information to be
collected; and (d) ways to minimize the
burden of the collection of information
on respondents, including through the
use of automated collection techniques
or other forms of information
technology.
Proposed Project: Federally Qualified
Health Centers (FQHC) Application
Forms: (OMB No. 0915–0285 Revisions)
HRSA’s Bureau of Primary Health
Care Federally Qualified Health Centers
(FQHCs) are a major component of
America’s health care safety net, the
Nation’s ‘‘system’’ of providing health
care to low-income and other vulnerable
populations. Health Centers care for
people regardless of their ability to pay
and whether or not they have health
insurance. They provide primary and
preventive health care, as well as
services such as transportation and
translation. Many Health Centers also
offer dental, mental health and
substance abuse care.
FQHC’s are administered by the
Health Resources and Services
Administration’s (HRSA) Bureau of
Primary Health Care (BPHC). HRSA uses
the following application forms to
administer and manage the FQHCs.
These application forms are used by
new and existing FQHCs to apply for
grant and non-grant opportunities,
renew their grant or non-grant
opportunities or change their scope of
project.
Estimates of annualized reporting
burden are as follows:
E:\FR\FM\29MRN1.SGM
29MRN1
15437
Federal Register / Vol. 75, No. 59 / Monday, March 29, 2010 / Notices
Number of
respondents
Type of application form
Responses
per
respondent
Total
responses
Hours per
response
Total burden
hours
General Information Worksheet ...........................................
Planning Grant: General Information Worksheet ................
BPHC Funding Request Summary ......................................
Documents on File ...............................................................
Proposed Staff Profile ..........................................................
Income Analysis Form .........................................................
Community Characteristics ..................................................
Health Care Plan (Competing) ............................................
Health Care Plan (Non-Competing) .....................................
Business Plan (Competing) .................................................
Business Plan (Non-Competing) .........................................
Services Provided ................................................................
Sites Listing ..........................................................................
Other Site Activities .............................................................
Change In Scope (CIS) Site Add Checklist .........................
CIS Site Delete Checklist ....................................................
CIS Relocation Checklist .....................................................
CIS Service Add Checklist ...................................................
CIS Service Delete Checklist ...............................................
Board Member Characteristics ............................................
Request for Waiver of Governance Requirements .............
Health Center Affiliation Certification ...................................
Need for Assistance .............................................................
Emergency Preparedness Form ..........................................
Points of Contact .................................................................
EHR Readiness Checklist ....................................................
Environmental Information and Documentation (EID) .........
Assurances ..........................................................................
Equipment List .....................................................................
Other Requirements for Sites ..............................................
1,034
250
1,034
1,034
1,034
1,034
1,034
800
1,034
800
1,034
1,034
1,034
700
300
200
200
100
100
1,034
150
250
900
1,034
800
250
400
900
900
900
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1,034
250
1,034
1,034
1,034
1,034
1,034
1,034
1,034
1,034
1,034
1,034
1,034
700
300
200
200
200
100
1,034
150
250
900
1,034
800
250
400
900
900
900
2.0
2.5
2.0
1.0
2.0
5.0
1.0
4.0
2.0
4.0
2.0
1.0
1.0
0.5
1.0
1.0
1.5
1.0
1.0
1.0
1.0
1.0
3.0
1.0
0.5
1.0
2.0
.5
1.0
.5
2,068
625
2,068
1,034
2,068
5,170
1,034
4,136
2,068
4,136
2,068
1,034
1,034
350
300
200
300
200
100
1,034
150
250
2,700
1,034
400
250
800
450
900
450
Total ..............................................................................
1,034
1
21,876
........................
38,411
E-mail comments to
paperwork@hrsa.gov or mail the HRSA
Reports Clearance Officer, Room 10–33,
Parklawn Building, 5600 Fishers Lane,
Rockville, MD 20857. Written comments
should be received within 60 days of
this notice.
Dated: March 22,2010.
Sahira Rafiullah,
Director, Division of Policy and Information
Coordination.
[FR Doc. 2010–6880 Filed 3–26–10; 8:45 am]
BILLING CODE 4165–15–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Substance Abuse and Mental Health
Services Administration
cprice-sewell on DSK89S0YB1PROD with NOTICES
Agency Information Collection
Activities: Proposed Collection;
Comment Request
In compliance with section
3506(c)(2)(A) of the Paperwork
Reduction Act of 1995 concerning
opportunity for public comment on
proposed collections of information, the
Substance Abuse and Mental Health
Services Administration (SAMHSA)
will publish periodic summaries of
proposed projects. To request more
VerDate Nov<24>2008
09:18 Apr 05, 2010
Jkt 220001
information on the proposed projects or
to obtain a copy of the information
collection plans, call the SAMHSA
Reports Clearance Officer on (240)
276–1243.
Comments are invited on: (a) Whether
the proposed collections of information
are necessary for the proper
performance of the functions of the
agency, including whether the
information shall have practical utility;
(b) the accuracy of the agency’s estimate
of the burden of the proposed collection
of information; (c) ways to enhance the
quality, utility, and clarity of the
information to be collected; and (d)
ways to minimize the burden of the
collection of information on
respondents, including through the use
of automated collection techniques or
other forms of information technology.
Proposed Project: SAMHSA
Application for Peer Grant Reviewers
(OMB No. 0930–0255)—Extension
Section 501(h) of the Public Health
Service (PHS) Act (42 U.S.C. 290aa)
directs the Administrator of the
Substance Abuse and Mental Health
Services Administration (SAMHSA) to
establish such peer review groups as are
needed to carry out the requirements of
Title V of the PHS Act. SAMHSA
administers a large discretionary grants
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Fmt 4703
Sfmt 4703
program under authorization of Title V,
and, for many years, SAMHSA has
funded grants to provide prevention and
treatment services related to substance
abuse and mental health.
In support of its grant peer review
efforts, SAMHSA desires to continue to
expand the number and types of
reviewers it uses on these grant review
committees. To accomplish that end,
SAMHSA has determined that it is
important to proactively seek the
inclusion of new and qualified
representatives on its peer review
groups. Accordingly SAMHSA has
developed an application form for use
by individuals who wish to apply to
serve as peer reviewers.
The application form has been
developed to capture the essential
information about the individual
applicants. Although consideration was
given to requesting a resume from
interested individuals, it is essential to
have specific information from all
applicants about their qualifications.
The most consistent method to
accomplish this is through completion
of a standard form by all interested
persons which captures information
about knowledge, education, and
experience in a consistent manner from
all interested applicants. SAMHSA will
use the information provided on the
E:\FR\FM\29MRN1.SGM
29MRN1
]]>Agencies
[Federal Register Volume 75, Number 59 (Monday, March 29, 2010)]
[Notices]
[Pages 15436-15437]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-6880]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
Agency Information Collection Activities: Proposed Collection:
Comment Request
In compliance with the requirement for opportunity for public
comment on proposed data collection projects (section 3506(c)(2)(A) of
Title 44, United States Code, as amended by the Paperwork Reduction Act
of 1995, Pub. L. 104-13), the Health Resources and Services
Administration (HRSA) publishes periodic summaries of proposed projects
being developed for submission to the Office of Management and Budget
(OMB) under the Paperwork Reduction Act of 1995. To request more
information on the proposed project or to obtain a copy of the data
collection plans and draft instruments, e-mail paperwork@hrsa.gov or
call the HRSA Reports Clearance Officer at (301) 443-1129.
Comments are invited on: (a) The proposed collection of information
for the proper performance of the functions of the agency; (b) the
accuracy of the agency's estimate of the burden of the proposed
collection of information; (c) ways to enhance the quality, utility,
and clarity of the information to be collected; and (d) ways to
minimize the burden of the collection of information on respondents,
including through the use of automated collection techniques or other
forms of information technology.
Proposed Project: Federally Qualified Health Centers (FQHC) Application
Forms: (OMB No. 0915-0285 Revisions)
HRSA's Bureau of Primary Health Care Federally Qualified Health
Centers (FQHCs) are a major component of America's health care safety
net, the Nation's ``system'' of providing health care to low-income and
other vulnerable populations. Health Centers care for people regardless
of their ability to pay and whether or not they have health insurance.
They provide primary and preventive health care, as well as services
such as transportation and translation. Many Health Centers also offer
dental, mental health and substance abuse care.
FQHC's are administered by the Health Resources and Services
Administration's (HRSA) Bureau of Primary Health Care (BPHC). HRSA uses
the following application forms to administer and manage the FQHCs.
These application forms are used by new and existing FQHCs to apply for
grant and non-grant opportunities, renew their grant or non-grant
opportunities or change their scope of project.
Estimates of annualized reporting burden are as follows:
[[Page 15437]]
----------------------------------------------------------------------------------------------------------------
Number of Responses per Total Hours per Total burden
Type of application form respondents respondent responses response hours
----------------------------------------------------------------------------------------------------------------
General Information Worksheet... 1,034 1 1,034 2.0 2,068
Planning Grant: General 250 1 250 2.5 625
Information Worksheet..........
BPHC Funding Request Summary.... 1,034 1 1,034 2.0 2,068
Documents on File............... 1,034 1 1,034 1.0 1,034
Proposed Staff Profile.......... 1,034 1 1,034 2.0 2,068
Income Analysis Form............ 1,034 1 1,034 5.0 5,170
Community Characteristics....... 1,034 1 1,034 1.0 1,034
Health Care Plan (Competing).... 800 1 1,034 4.0 4,136
Health Care Plan (Non-Competing) 1,034 1 1,034 2.0 2,068
Business Plan (Competing)....... 800 1 1,034 4.0 4,136
Business Plan (Non-Competing)... 1,034 1 1,034 2.0 2,068
Services Provided............... 1,034 1 1,034 1.0 1,034
Sites Listing................... 1,034 1 1,034 1.0 1,034
Other Site Activities........... 700 1 700 0.5 350
Change In Scope (CIS) Site Add 300 1 300 1.0 300
Checklist......................
CIS Site Delete Checklist....... 200 1 200 1.0 200
CIS Relocation Checklist........ 200 1 200 1.5 300
CIS Service Add Checklist....... 100 1 200 1.0 200
CIS Service Delete Checklist.... 100 1 100 1.0 100
Board Member Characteristics.... 1,034 1 1,034 1.0 1,034
Request for Waiver of Governance 150 1 150 1.0 150
Requirements...................
Health Center Affiliation 250 1 250 1.0 250
Certification..................
Need for Assistance............. 900 1 900 3.0 2,700
Emergency Preparedness Form..... 1,034 1 1,034 1.0 1,034
Points of Contact............... 800 1 800 0.5 400
EHR Readiness Checklist......... 250 1 250 1.0 250
Environmental Information and 400 1 400 2.0 800
Documentation (EID)............
Assurances...................... 900 1 900 .5 450
Equipment List.................. 900 1 900 1.0 900
Other Requirements for Sites.... 900 1 900 .5 450
-------------------------------------------------------------------------------
Total....................... 1,034 1 21,876 .............. 38,411
----------------------------------------------------------------------------------------------------------------
E-mail comments to paperwork@hrsa.gov or mail the HRSA Reports
Clearance Officer, Room 10-33, Parklawn Building, 5600 Fishers Lane,
Rockville, MD 20857. Written comments should be received within 60 days
of this notice.
Dated: March 22,2010.
Sahira Rafiullah,
Director, Division of Policy and Information Coordination.
[FR Doc. 2010-6880 Filed 3-26-10; 8:45 am]
BILLING CODE 4165-15-P
