Agency Information Collection Activities: Proposed Collection: Comment Request, 15436-15437 [2010-6880]

Download as PDF 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 http://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 PO 00000 Frm 00037 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

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[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]


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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