Agency Information Collection Activities: Proposed Collection; Comment Request, 69677-69679 [2010-28367]

Download as PDF 69677 Federal Register / Vol. 75, No. 219 / Monday, November 15, 2010 / Notices EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN—Continued Number of respondents Form name Total .......................................................................................................... Total burden hours 977 Average hourly wage rate* 1,190 n/a Total cost burden 27,316 * Based upon the mean of the wages for 11–9111 Medical & Health Services Manager ($43.74), 29–000 Healthcare Practitioner and Technical Occupations ($33.51), 43–6011 Executive Secretaries and Administrative Assistants ($21.16) and 00–0000 All Occupations ($20.90), May 2009 National Occupational Employment and Wage Estimates. United States, ‘‘U.S. Department of Labor, Bureau of Labor Statistics.’’ http:// www.bls.gov/oes/current/oes_nat.htm#b29–0000. Estimated Annual Costs to the Federal Government Exhibit 3 below breaks down the costs related to this study. Since this study will span two years, the costs have been annualized over a two year period. The total annualized cost is estimated to be $536,396.50. EXHIBIT 3—ESTIMATED TOTAL AND ANNUALIZED COST Cost component Total cost Guide Development ............................................................................................................................................... Data Collection Activities ....................................................................................................................................... Data Processing and Analysis ............................................................................................................................... Project Management .............................................................................................................................................. Overhead ............................................................................................................................................................... $526,214 310,006 110,620 20,270 105,683 Total ................................................................................................................................................................ 1,072,793 srobinson on DSKHWCL6B1PROD with NOTICES Request for Comments In accordance with the above-cited Paperwork Reduction Act legislation, comments on AHRQ’s information collection are requested with regard to any of the following: (a) Whether the proposed collection of information is necessary for the proper performance of AHRQ healthcare research and healthcare information dissemination functions, including whether the information will have practical utility; (b) the accuracy of AHRQ’s estimate of burden (including hours and costs) of the proposed collection(s) 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 upon the respondents, including the use of automated collection techniques or other forms of information technology. Comments submitted in response to this notice will be summarized and included in the Agency’s subsequent request for OMB approval of the proposed information collection. All comments will become a matter of public record. Dated: November 1, 2010. Carolyn M. Clancy, Director. [FR Doc. 2010–28368 Filed 11–12–10; 8:45 am] BILLING CODE 4160–90–M VerDate Mar<15>2010 18:04 Nov 12, 2010 Jkt 223001 DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Agency Information Collection Activities: Proposed Collection; Comment Request Agency for Healthcare Research and Quality, HHS. ACTION: Notice. AGENCY: This notice announces the intention of the Agency for Healthcare Research and Quality (AHRQ) to request that the Office of Management and Budget (OMB) approve the proposed information collection project: ‘‘Standardizing Antibiotic Use in Longterm Care Settings.’’ In accordance with the Paperwork Reduction Act, 44 U.S.C. 3501–3520, AHRQ invites the public to comment on this proposed information collection. DATES: Comments on this notice must be received by January 14, 2011. ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, Reports Clearance Officer, AHRQ, by email at doris.lefkowitz@AHRQ. hhs.gov. Copies of the proposed collection plans, data collection instruments, and specific details on the estimated burden can be obtained from the AHRQ Reports Clearance Officer. FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports SUMMARY: PO 00000 Frm 00059 Fmt 4703 Sfmt 4703 Annualized cost $263,107 155,003 55,310 10,135 52,842 536,396.50 Clearance Officer, (301) 427–1477, or by e-mail at doris.lefkowitz@AHRQ.hhs.gov. SUPPLEMENTARY INFORMATION: Proposed Project Standardizing Antibiotic Use in Longterm Care Settings This project seeks to contribute to AHRQ’s mission by optimizing antibiotic prescribing practices in nursing homes. Nursing homes serve as one of our most fertile breeding grounds for antibiotic-resistant strains of bacteria. Nursing home residents, with their combination of the effects of normal aging and multiple chronic diseases, have relatively high rates of infection. With high rates of respiratory, urinary, skin, and other infection comes a very high rate of antibiotic use that gives rise to Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococci (VRE), fluoroquinolone-resistant strains of a variety of bacteria, and multi-drug resistant organisms (MDROs). Inappropriate antibiotic prescribing practices by primary care clinicians caring for residents in long-term care (LTC) communities is becoming a major public health concern. Antibiotics are among the most commonly prescribed pharmaceuticals in LTC settings, yet reports indicate that a high proportion of antibiotic prescriptions are inappropriate. In an effort to reduce antibiotic overprescribing, Loeb and colleagues E:\FR\FM\15NON1.SGM 15NON1 69678 Federal Register / Vol. 75, No. 219 / Monday, November 15, 2010 / Notices srobinson on DSKHWCL6B1PROD with NOTICES developed minimum criteria for the initiation of antibiotics in LTC setting. The criteria have been tested in several studies, but their implementation and tests of validity have been limited. In particular, though Loeb and colleagues developed distinct minimum criteria for several types of infection (skin and softtissue, respiratory, urinary tract, and unexplained fever), a rigorous evaluation has been conducted only for urinary tract infections. This project will assess an approach to using the Loeb criteria that requires minimal changes in facility procedures and, therefore, is likely to be widely adopted by nursing homes. The intervention makes use of a Communication and Order Form (COF), which has been designed by the researchers and will be used by the nurses and physicians to guide their decisionmaking about whether to order an antibiotic for a specific resident experiencing a specific infection. Twelve nursing homes will participate in this project with eight assigned to the intervention and four serving as controls. The eight intervention sites will be divided into two groups of four sites each, with one group receiving an additional follow-up training 2 months after the intervention. The objectives of the study are to: 1. Implement a quality improvement (01) intervention program to optimize antibiotic prescribing practices; 2. Evaluate the effect of the 01 intervention on antibiotic prescribing practices including validation of the Loeb minimum criteria; and 3. Develop and execute a dissemination plan to ensure wide dissemination of the findings and recommendations for improving antibiotic prescribing behaviors in LTC settings. This study is being conducted by AHRQ through its contractor, the American Institutes for Research (AIR), pursuant to AHRQ’s statutory authority to conduct and support research on healthcare and on systems for the delivery of such care, including activities with respect to the quality, effectiveness, efficiency, appropriateness, and value of healthcare services and with respect to quality measurement and improvement. 42 U.S.C. 299a (a) (1) and (2). Method of Collection The following data collection activities and trainings will be implemented to achieve the first two objectives of this project: 1. Loeb criteria communication and Order Form—This form will be completed by staff in the eight VerDate Mar<15>2010 18:04 Nov 12, 2010 Jkt 223001 intervention nursing homes to determine if the Loeb criteria have been met. The COF provides a logical decision model for determining the need for an antibiotic. Facility staff will complete the paper form and the data from the forms will be entered into a database by the project researchers. Based on a preliminary review of the infection logs at 4 nursing homes, we estimate that staff nurses will complete an average of 17 COFs per month per nursing home at the 8 nursing homes that will use the COF during the 6month intervention period. 2. Medical record reviews (MMR)—To be conducted by research staff to collect outcome data to determine antibiotic prescribing practices and their effects and to assess the resident’s health and functional status, which are potentially important control variables. Outcome and control variables will be obtained by monthly chart review and review of the Nursing Home Minimum Data Set (MDS) for a period of nine months: three months preceding the initiation of the 01 intervention (for which the charts of all eligible residents will be abstracted for a 3-month period at one time), and every other month during a 6-month period following the inception of the intervention (for which the charts of all eligible residents will be abstracted for the preceding two months. AHRQ’s contractor will conduct the data abstraction at all 12 facilities (treatment and control). Since this data collection will not impose a burden on the facility staff, OMB clearance is not required. 3. Staff training—Prior to implementation, the staff (administrators, nurses, and physicians) at all eight intervention sites will be trained in the proper use of the Loeb Criteria COF. Staff at four of the intervention sites will be trained a second time 2 months after the initial training. We estimate that an average of 24 nurses and 2 physicians will be trained at each nursing home. 4. Pre-implementation semistructured interview—The purpose of this interview is to gain an understanding of: (1) How the staff and the department(s) and/or wider facility perceive quality improvement, in general; (2) the amount of experience the site has in QI and its processes for handling infections; (3) why the facility decided to adopt the Loeb Criteria COF; and (4) the facility’s goals for the Loeb Criteria COF implementation. Four staff members will be interviewed at each nursing home: two champions (likely the administrator, director of nursing, and/or the assistant director of nursing), PO 00000 Frm 00060 Fmt 4703 Sfmt 4703 one line nurse, and one staff physician. Questions vary by respondent type. 5. Post-training semi-structured interview—The purpose of this interview is to measure the staff’s: (1) Perceived adequacy of the training; (2) their reactions to the training; and (3) their plans for implementation. The same four persons at each nursing home who were interviewed for the preimplementation semi-structured interviews will participate in this interview. Questions vary by respondent type. 6. Post-implementation semistructured interview—The purpose of this interview is to identify: (1) Facilitators and barriers to implementation; (2) how barriers were overcome; (3) what barriers remain; (4) perceived impacts of the Loeb Criteria COF on the use of antibiotics within the facility; and (5) the facility’s view on the business case for Loeb Criteria COF. The same four persons at each nursing home who participated in the previous semistructured interviews will participate in this interview. Questions do not vary by respondent type. Estimated Annual Respondent Burden Exhibit 1 shows the estimated annualized burden hours for the nursing homes’ time to participate in this project. All of the data collections and training in Exhibit 1 pertain only to the eight intervention nursing homes. The Loeb Criteria COF will be completed approximately 17 times a month for 6 months (102 total) by staff at each nursing home and will require about 5 minutes to complete. Staff training will be attended by all nursing and medical staff members at each nursing home (an average of 24 nurses and two physicians per facility) and will last 1 hour. All eight intervention facilities will receive training once at the start of the intervention and four of the eight facilities will receive a second training one month later to see if reinforcement results in improved performance. The pre-implementation, post training and post-implementation semi-structured interviews will be completed by the same four staff members at each nursing home consisting of two champions (likely the administrator, director of nursing, and/or the assistant director of nursing), one line nurse, and one staff physician. Each interview will be scheduled for 1 hour. The total annual burden is estimated to be 476 hours. Exhibit 2 shows the estimated annual cost burden associated with the respondents’ time to participate in this project. The total annual cost burden is estimated to be $17,508. E:\FR\FM\15NON1.SGM 15NON1 69679 Federal Register / Vol. 75, No. 219 / Monday, November 15, 2010 / Notices EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS Number of nursing homes Number of responses per nursing home Loeb Criteria COF Staff training ...................................................................... Initial Training .................................................................................................. Re-training ....................................................................................................... Pre-implementation semi-structured interview ................................................. Post training semi-structured interview ............................................................ Post-implementation semi-structured interview ............................................... 8 8 4 8 8 8 102 26 26 4 4 4 5/60 1 1 1 1 1 68 208 104 32 32 32 Total .......................................................................................................... 44 na na 476 Form name Hours per response Total burden hours EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN Number of nursing homes Form name Total burden hours Average hourly wage rate* Total burden Loeb Criteria COF Staff training ...................................................................... Initial Training .................................................................................................. Re-training ....................................................................................................... Pre-implementation semi-structured interview ................................................. Post training semi-structured interview ............................................................ Post-implementation semi-structured interview ............................................... 8 8 8 8 8 8 68 208 104 32 32 32 $33 36 36 42 42 42 $2,244 7,488 3,744 1,344 1,344 1,344 Total .......................................................................................................... 44 476 na 17,508 * Based upon the mean of the average wages, National Compensation Survey: Occupational wages in the United States May 2009, ‘‘U.S. Department of Labor, Bureau of Labor Statistics.’’ $33 is the average wage for nurses who will complete the COF. $36 is the weighted average wage of 24 nurses at $33 per hour and 2 physicians at $70 per hour who will be trained. $42 is the weighted average wage of 3 nurses and administrators at $33 per hour and 1 physician at $70 per hour who will be interviewed. Estimated Annual Costs to the Federal Government Exhibit 3 shows the estimated total and annual cost to the government for funding this project. Although data collection will require less than one year, the entire project will span 2 years. The total cost of this research is estimated to be $999,554. EXHIBIT 3—ESTIMATED TOTAL AND ANNUALIZED COST Cost component Total cost Annualized cost Project Development ............................................................................................................................................... Data Collection Activities ......................................................................................................................................... Data Processing and Analysis ................................................................................................................................. Publication of Results .............................................................................................................................................. Project Management ................................................................................................................................................ Overhead ................................................................................................................................................................. $103,498 361,178 193,830 48,497 65,334 227,217 $51,749 180,589 96,915 24,249 32,667 113,609 Total .................................................................................................................................................................. $999,554 $499,777 srobinson on DSKHWCL6B1PROD with NOTICES Request for Comments In accordance with the above-cited Paperwork Reduction Act legislation, comments on AHRQ’s information collection are requested with regard to any of the following: (a) Whether the proposed collection of information is necessary for the proper performance of AHRQ healthcare research and healthcare information dissemination functions, including whether the information will have practical utility; (b) the accuracy of AHRQ’s estimate of burden (including hours and costs) of the proposed collection(s) of information; (c) ways to enhance the VerDate Mar<15>2010 18:04 Nov 12, 2010 Jkt 223001 quality, utility, and clarity of the information to be collected; and (d) ways to minimize the burden of the collection of information upon the respondents, including the use of automated collection techniques or other forms of information technology. Comments submitted in response to this notice will be summarized and included in the Agency’s subsequent request for OMB approval of the proposed information collection. All comments will become a matter of public record. PO 00000 Frm 00061 Fmt 4703 Sfmt 9990 Dated: November 4, 2010. Carolyn M. Clancy, Director. [FR Doc. 2010–28367 Filed 11–12–10; 8:45 am] BILLING CODE 4160–90–M E:\FR\FM\15NON1.SGM 15NON1

Agencies

[Federal Register Volume 75, Number 219 (Monday, November 15, 2010)]
[Notices]
[Pages 69677-69679]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-28367]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Agency for Healthcare Research and Quality, HHS.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: This notice announces the intention of the Agency for 
Healthcare Research and Quality (AHRQ) to request that the Office of 
Management and Budget (OMB) approve the proposed information collection 
project: ``Standardizing Antibiotic Use in Long-term Care Settings.'' 
In accordance with the Paperwork Reduction Act, 44 U.S.C. 3501-3520, 
AHRQ invites the public to comment on this proposed information 
collection.

DATES: Comments on this notice must be received by January 14, 2011.

ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, 
Reports Clearance Officer, AHRQ, by e-mail at hhs.gov">doris.lefkowitz@AHRQ.hhs.gov.
    Copies of the proposed collection plans, data collection 
instruments, and specific details on the estimated burden can be 
obtained from the AHRQ Reports Clearance Officer.

FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports 
Clearance Officer, (301) 427-1477, or by e-mail at 
hhs.gov">doris.lefkowitz@AHRQ.hhs.gov.

SUPPLEMENTARY INFORMATION: 

Proposed Project

Standardizing Antibiotic Use in Long-term Care Settings

    This project seeks to contribute to AHRQ's mission by optimizing 
antibiotic prescribing practices in nursing homes. Nursing homes serve 
as one of our most fertile breeding grounds for antibiotic-resistant 
strains of bacteria. Nursing home residents, with their combination of 
the effects of normal aging and multiple chronic diseases, have 
relatively high rates of infection. With high rates of respiratory, 
urinary, skin, and other infection comes a very high rate of antibiotic 
use that gives rise to Methicillin-resistant Staphylococcus aureus 
(MRSA), Vancomycin-resistant Enterococci (VRE), fluoroquinolone-
resistant strains of a variety of bacteria, and multi-drug resistant 
organisms (MDROs). Inappropriate antibiotic prescribing practices by 
primary care clinicians caring for residents in long-term care (LTC) 
communities is becoming a major public health concern. Antibiotics are 
among the most commonly prescribed pharmaceuticals in LTC settings, yet 
reports indicate that a high proportion of antibiotic prescriptions are 
inappropriate.
    In an effort to reduce antibiotic overprescribing, Loeb and 
colleagues

[[Page 69678]]

developed minimum criteria for the initiation of antibiotics in LTC 
setting. The criteria have been tested in several studies, but their 
implementation and tests of validity have been limited. In particular, 
though Loeb and colleagues developed distinct minimum criteria for 
several types of infection (skin and soft-tissue, respiratory, urinary 
tract, and unexplained fever), a rigorous evaluation has been conducted 
only for urinary tract infections.
    This project will assess an approach to using the Loeb criteria 
that requires minimal changes in facility procedures and, therefore, is 
likely to be widely adopted by nursing homes. The intervention makes 
use of a Communication and Order Form (COF), which has been designed by 
the researchers and will be used by the nurses and physicians to guide 
their decisionmaking about whether to order an antibiotic for a 
specific resident experiencing a specific infection. Twelve nursing 
homes will participate in this project with eight assigned to the 
intervention and four serving as controls. The eight intervention sites 
will be divided into two groups of four sites each, with one group 
receiving an additional follow-up training 2 months after the 
intervention.
    The objectives of the study are to:
    1. Implement a quality improvement (01) intervention program to 
optimize antibiotic prescribing practices;
    2. Evaluate the effect of the 01 intervention on antibiotic 
prescribing practices including validation of the Loeb minimum 
criteria; and
    3. Develop and execute a dissemination plan to ensure wide 
dissemination of the findings and recommendations for improving 
antibiotic prescribing behaviors in LTC settings.
    This study is being conducted by AHRQ through its contractor, the 
American Institutes for Research (AIR), pursuant to AHRQ's statutory 
authority to conduct and support research on healthcare and on systems 
for the delivery of such care, including activities with respect to the 
quality, effectiveness, efficiency, appropriateness, and value of 
healthcare services and with respect to quality measurement and 
improvement. 42 U.S.C. 299a (a) (1) and (2).

Method of Collection

    The following data collection activities and trainings will be 
implemented to achieve the first two objectives of this project:
    1. Loeb criteria communication and Order Form--This form will be 
completed by staff in the eight intervention nursing homes to determine 
if the Loeb criteria have been met. The COF provides a logical decision 
model for determining the need for an antibiotic. Facility staff will 
complete the paper form and the data from the forms will be entered 
into a database by the project researchers. Based on a preliminary 
review of the infection logs at 4 nursing homes, we estimate that staff 
nurses will complete an average of 17 COFs per month per nursing home 
at the 8 nursing homes that will use the COF during the 6-month 
intervention period.
    2. Medical record reviews (MMR)--To be conducted by research staff 
to collect outcome data to determine antibiotic prescribing practices 
and their effects and to assess the resident's health and functional 
status, which are potentially important control variables. Outcome and 
control variables will be obtained by monthly chart review and review 
of the Nursing Home Minimum Data Set (MDS) for a period of nine months: 
three months preceding the initiation of the 01 intervention (for which 
the charts of all eligible residents will be abstracted for a 3-month 
period at one time), and every other month during a 6-month period 
following the inception of the intervention (for which the charts of 
all eligible residents will be abstracted for the preceding two months. 
AHRQ's contractor will conduct the data abstraction at all 12 
facilities (treatment and control). Since this data collection will not 
impose a burden on the facility staff, OMB clearance is not required.
    3. Staff training--Prior to implementation, the staff 
(administrators, nurses, and physicians) at all eight intervention 
sites will be trained in the proper use of the Loeb Criteria COF. Staff 
at four of the intervention sites will be trained a second time 2 
months after the initial training. We estimate that an average of 24 
nurses and 2 physicians will be trained at each nursing home.
    4. Pre-implementation semi-structured interview--The purpose of 
this interview is to gain an understanding of: (1) How the staff and 
the department(s) and/or wider facility perceive quality improvement, 
in general; (2) the amount of experience the site has in QI and its 
processes for handling infections; (3) why the facility decided to 
adopt the Loeb Criteria COF; and (4) the facility's goals for the Loeb 
Criteria COF implementation. Four staff members will be interviewed at 
each nursing home: two champions (likely the administrator, director of 
nursing, and/or the assistant director of nursing), one line nurse, and 
one staff physician. Questions vary by respondent type.
    5. Post-training semi-structured interview--The purpose of this 
interview is to measure the staff's: (1) Perceived adequacy of the 
training; (2) their reactions to the training; and (3) their plans for 
implementation. The same four persons at each nursing home who were 
interviewed for the pre-implementation semi-structured interviews will 
participate in this interview. Questions vary by respondent type.
    6. Post-implementation semi-structured interview--The purpose of 
this interview is to identify: (1) Facilitators and barriers to 
implementation; (2) how barriers were overcome; (3) what barriers 
remain; (4) perceived impacts of the Loeb Criteria COF on the use of 
antibiotics within the facility; and (5) the facility's view on the 
business case for Loeb Criteria COF. The same four persons at each 
nursing home who participated in the previous semi-structured 
interviews will participate in this interview. Questions do not vary by 
respondent type.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for the 
nursing homes' time to participate in this project. All of the data 
collections and training in Exhibit 1 pertain only to the eight 
intervention nursing homes. The Loeb Criteria COF will be completed 
approximately 17 times a month for 6 months (102 total) by staff at 
each nursing home and will require about 5 minutes to complete. Staff 
training will be attended by all nursing and medical staff members at 
each nursing home (an average of 24 nurses and two physicians per 
facility) and will last 1 hour. All eight intervention facilities will 
receive training once at the start of the intervention and four of the 
eight facilities will receive a second training one month later to see 
if reinforcement results in improved performance. The pre-
implementation, post training and post-implementation semi-structured 
interviews will be completed by the same four staff members at each 
nursing home consisting of two champions (likely the administrator, 
director of nursing, and/or the assistant director of nursing), one 
line nurse, and one staff physician. Each interview will be scheduled 
for 1 hour. The total annual burden is estimated to be 476 hours.
    Exhibit 2 shows the estimated annual cost burden associated with 
the respondents' time to participate in this project. The total annual 
cost burden is estimated to be $17,508.

[[Page 69679]]



                                  Exhibit 1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
                                                                     Number of
                    Form name                        Number of     responses per     Hours per     Total burden
                                                   nursing homes   nursing home      response          hours
----------------------------------------------------------------------------------------------------------------
Loeb Criteria COF Staff training................               8             102            5/60              68
Initial Training................................               8              26               1             208
Re-training.....................................               4              26               1             104
Pre-implementation semi-structured interview....               8               4               1              32
Post training semi-structured interview.........               8               4               1              32
Post-implementation semi-structured interview...               8               4               1              32
                                                 ---------------------------------------------------------------
    Total.......................................              44              na              na             476
----------------------------------------------------------------------------------------------------------------


                                   Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
                                                     Number of     Total burden   Average hourly
                    Form name                      nursing homes       hours        wage rate*     Total burden
----------------------------------------------------------------------------------------------------------------
Loeb Criteria COF Staff training................               8              68             $33          $2,244
Initial Training................................               8             208              36           7,488
Re-training.....................................               8             104              36           3,744
Pre-implementation semi-structured interview....               8              32              42           1,344
Post training semi-structured interview.........               8              32              42           1,344
Post-implementation semi-structured interview...               8              32              42           1,344
                                                 ---------------------------------------------------------------
    Total.......................................              44             476              na          17,508
                                                 ---------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------
* Based upon the mean of the average wages, National Compensation Survey: Occupational wages in the United
  States May 2009, ``U.S. Department of Labor, Bureau of Labor Statistics.'' $33 is the average wage for nurses
  who will complete the COF. $36 is the weighted average wage of 24 nurses at $33 per hour and 2 physicians at
  $70 per hour who will be trained. $42 is the weighted average wage of 3 nurses and administrators at $33 per
  hour and 1 physician at $70 per hour who will be interviewed.

Estimated Annual Costs to the Federal Government

    Exhibit 3 shows the estimated total and annual cost to the 
government for funding this project. Although data collection will 
require less than one year, the entire project will span 2 years. The 
total cost of this research is estimated to be $999,554.

             Exhibit 3--Estimated Total and Annualized Cost
------------------------------------------------------------------------
                                                            Annualized
             Cost component                 Total cost         cost
------------------------------------------------------------------------
Project Development.....................        $103,498         $51,749
Data Collection Activities..............         361,178         180,589
Data Processing and Analysis............         193,830          96,915
Publication of Results..................          48,497          24,249
Project Management......................          65,334          32,667
Overhead................................         227,217         113,609
                                         -------------------------------
    Total...............................        $999,554        $499,777
------------------------------------------------------------------------

Request for Comments

    In accordance with the above-cited Paperwork Reduction Act 
legislation, comments on AHRQ's information collection are requested 
with regard to any of the following: (a) Whether the proposed 
collection of information is necessary for the proper performance of 
AHRQ healthcare research and healthcare information dissemination 
functions, including whether the information will have practical 
utility; (b) the accuracy of AHRQ's estimate of burden (including hours 
and costs) of the proposed collection(s) 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 upon the respondents, including the use of automated 
collection techniques or other forms of information technology.
    Comments submitted in response to this notice will be summarized 
and included in the Agency's subsequent request for OMB approval of the 
proposed information collection. All comments will become a matter of 
public record.

    Dated: November 4, 2010.
Carolyn M. Clancy,
Director.
[FR Doc. 2010-28367 Filed 11-12-10; 8:45 am]
BILLING CODE 4160-90-M