Agency Information Collection Activities: Submission for OMB Review; Comment Request, 65514-65515 [2011-27300]
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Federal Register / Vol. 76, No. 204 / Friday, October 21, 2011 / Notices
ESTIMATED ANNUALIZED BURDEN HOURS
Form name
Student Program Participant ...........................
Student Outcome Survey Baseline—Appendix D.
Student Outcome Survey Follow-up—Appendix E.
School Indicators—Appendix F ......................
Parent Outcome Survey—Appendix G ..........
Educator Outcome Survey—Appendix H ......
Brand Ambassador Implementation Survey—
Appendix I.
School Leadership Capacity and Readiness
Survey—Appendix J.
Parent Program Fidelity 6th Grade Sessions
1–5—Appendices K, L, M, N, O.
Parent Program Fidelity 7th Grade Sessions
1, 3–5—Appendices P, Q, R.
Safe Dates Implementation Survey—Appendix S.
Student Program Fidelity 6th Grade Session
1–6—Appendices T, U, V, W, X, Y.
Student Program Fidelity 7th Grade Sessions 1–6—Appendices Z–EE.
Student Program Fidelity 8th Grade Sessions 1–10—Appendices FF–OO.
Communications Campaign Tracking—Appendix PP.
Local Health Department Capacity and
Readiness—Appendix QQ.
Parent Program Capacity and Readiness—
Appendix RR.
Community Capacity and Readiness—Appendix SS.
Student Program Participant ...........................
School data extractor ......................................
Parent Program Participant ............................
Educator ..........................................................
Student Brand ambassador ............................
School leadership ...........................................
Parent Curricula Implementer (6th grade) ......
Parent Curricula Implementer (7th grade) ......
Safe Dates Implementer (implementation) .....
Student Curricula Implementer (6th grade) ....
Student Curricula Implementer (7th grade) ....
Student Curricula Implementer (8th grade) ....
Communications Implementer ........................
Local health department representative .........
Parent Program Manager ...............................
Community Representative .............................
Catina Conner,
Acting Reports Clearance Officer, Centers for
Disease Control and Prevention.
[FR Doc. 2011–27245 Filed 10–20–11; 8:45 am]
BILLING CODE 4163–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–10291 and CMS–
10403]
Agency Information Collection
Activities: Submission for OMB
Review; Comment Request
Centers for Medicare &
Medicaid Services, HHS.
In compliance with the requirement
of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the
Centers for Medicare & Medicaid
Services (CMS), Department of Health
and Human Services, is publishing the
following summary of proposed
collections for public comment.
Interested persons are invited to send
comments regarding this burden
estimate or any other aspect of this
sroberts on DSK5SPTVN1PROD with NOTICES
AGENCY:
VerDate Mar<15>2010
18:11 Oct 20, 2011
Jkt 226001
collection of information, including any
of the following subjects: (1) The
necessity and utility of the proposed
information collection for the proper
performance of the Agency’s function;
(2) the accuracy of the estimated
burden; (3) ways to enhance the quality,
utility, and clarity of the information to
be collected; and (4) the use of
automated collection techniques or
other forms of information technology to
minimize the information collection
burden.
1. Type of Information Collection
Request: Revision of a currently
approved collection; Title of
Information Collection: State Collection
and Reporting of Dental Provider and
Benefit Package Information on the
Insure Kids Now! Web site and Hotline;
Use: The Children’s Health Insurance
Program Reauthorization Act of 2009
(CHIPRA) sections 501(f)(1) and (2),
requires that state-specific information
on dental providers and benefits be
posted on the Insure Kids Now (IKN)
Web site and available on the hotline.
States must update the information on
the dental providers quarterly and the
information on their benefit package
annually. CMS is asking States to
submit their dental benefits in a revised
PO 00000
Frm 00022
Fmt 4703
Sfmt 4703
Number of
responses
per
respondent
Number of
respondents
Type of respondent
Average
burden per
response
(hours)
9600
1
1.5
9600
2
1.5
48
5760
1632
80
200
2
1
2
15/60
1
30/60
20/60
48
1
1
280
3
15/60
168
3
15/60
144
1
1
1728
1
15/60
1728
1
15/60
2880
1
15/60
4
4
20/60
16
1
2
4
1
1
40
1
1
format that is designed to reduce the
amount of time States have to spend in
compiling the dental benefit
information. Although in the past we
allowed States to only check a box to
indicate that the Medicaid dental
benefits were in compliance with Early
and Periodic Screening, Diagnostic and
Treatment (EPSDT) services, we are also
modifying the form to ask States to
include their Medicaid dental benefits
in this form so those may also be posted
on the Web site. In addition, we are
asking States to specify if they have a
dollar or code limit at which point prior
authorization is required for any
additional services and if they have cost
sharing requirements for dental services;
Form Number: CMS–10291 (OMB #:
0938–1065); Frequency: Yearly (dental
benefits) and quarterly (dental
providers); Affected Public: State, Local,
or Tribal Governments; Number of
Respondents: 51; Total Annual
Responses: 255; Total Annual Hours:
190. (For policy questions regarding this
collection contact Nancy Goetschius at
410–786–0707. For all other issues call
410–786–1326.)
2. Type of Information Collection
Request: New collection; Title of
Information Collection: Community-
E:\FR\FM\21OCN1.SGM
21OCN1
sroberts on DSK5SPTVN1PROD with NOTICES
Federal Register / Vol. 76, No. 204 / Friday, October 21, 2011 / Notices
based Care Transitions Program (CCTP)
Implementation and Monitoring; Use:
The Medicare Community-Based Care
Transitions Program (CCTP), authorized
by Section 3026 of the 2010 Affordable
Care Act, is a major component of the
Partnership for Patients initiative, one
goal of which is to decrease preventable
complications during transition from a
care setting, such as a hospital, to home,
community, or another care setting.
Appendix A contains a copy of the
relevant portion of the legislation.
The CCTP will provide funding to test
models for improving care transitions
from the hospital to the community for
high-risk Medicare beneficiaries. The
Centers for Medicare & Medicaid
Services (CMS) initiated the CCTP in
early 2011 and will operate the program
for five years. Congress has authorized
$500 million to cover the cost of the
program. CMS expects that program
agreements will be in place to authorize
community-based organizations (CBOs),
in partnership with acute care hospitals,
to begin providing care transition
services in November 2011 and, if
successful, continue doing so for up to
five years. The planned collection of a
participant experience survey is part of
the implementation and monitoring
strategy that will review the
performance of organizations contracted
to provide transitional care services
under the CCTP. This clearance package
seeks approval for the participant
experience survey.
Form Number: CMS–10403 (OMB #
0938–New); Frequency: Once; Affected
Public: Individuals or Households;
Number of Respondents: 50,000; Total
Annual Responses: 50,000; Total
Annual Hours: 12,500. (For policy
questions regarding this collection
contact Juliana Tiongson at 410–786–
0342. 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 November 21, 2011.
OMB, Office of Information and
Regulatory Affairs, Attention: CMS
Desk Officer.
VerDate Mar<15>2010
18:11 Oct 20, 2011
Jkt 226001
Fax Number: (202) 395–6974.
E-mail:
OIRA_submission@omb.eop.gov.
Dated: October 18, 2011.
Martique Jones,
Director, Regulations Development Group,
Division B, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2011–27300 Filed 10–20–11; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–10249]
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Centers for Medicare &
Medicaid Services, HHS.
In compliance with the requirement
of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the
Centers for Medicare & Medicaid
Services (CMS) is publishing the
following summary of proposed
collections for public comment.
Interested persons are invited to send
comments regarding this burden
estimate or any other aspect of this
collection of information, including any
of the following subjects: (1) The
necessity and utility of the proposed
information collection for the proper
performance of the agency’s functions;
(2) the accuracy of the estimated
burden; (3) ways to enhance the quality,
utility, and clarity of the information to
be collected; and (4) the use of
automated collection techniques or
other forms of information technology to
minimize the information collection
burden.
1. Type of Information Collection
Request: Revision of a currently
approved collection; Title of
Information Collection: Administrative
Requirements for Section 6071 of the
Deficit Reduction Act; Use: Under
section 6071 of the Deficit Reduction
Act of 2005 (P.L. 109–171) subsection
(c), the Secretary may require States to
meet requirements and provide
additional information, provisions, and
assurances. Through the Operational
Protocol, States provide the
requirements, information, provisions
and assurances which, following CMS
approval, States may enroll individuals
in the State’s demonstration program or
begin to claim for service dollars. The
Act also requires the Money Follows the
Person Rebalancing Demonstration
AGENCY:
PO 00000
Frm 00023
Fmt 4703
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65515
(MFP) program be evaluated to
determine program effectiveness. One
aspect of the evaluation is determining
participant quality of life and how the
program affects quality of life. Medicaid
enrollees who participate in the MFP
program are expected to have need for
long-term care services for the rest of
their lives and are a particularly
vulnerable population if the community
setting cannot adequately meet their
needs or does not provide them a
suitable quality of life.
State Operational Protocols should
provide enough information that: the
CMS Project Officer and other Federal
officials may use it to understand the
operation of the demonstration and/or
prepare for potential site visits without
needing additional information; the
State Project Director can use it as the
manual for program implementation;
and external stakeholders may use it to
understand the operation of the
demonstration. The financial
information collection will be used in
CMS financial statements and shared
with the auditors who validate CMS’
financial position. The Maintenance of
Effort forms as well as the MFP Budget
Form are required each year.
Submissions of MFP Demonstration
Financial Forms are 90 days after the
end of each Federal fiscal quarter. The
MFP Finders File, MFP Program
Participation Data file, and MFP
Services File will be used by the
national evaluation contractor to assess
program outcomes. The MFP Quality of
Life data will be used by the national
evaluation contractor to assess program
outcomes. Specifically, the evaluation
will determine how participants’ quality
of life changes after transitioning to the
community. The semi-annual progress
reports will be used by the national
evaluation contractor and CMS to
monitor program implementation at the
grantee level; Form Number: CMS–
10249 (OCN: 0938–1053); Frequency:
Yearly, Semi-annually, Quarterly, Once;
Affected Public: State, Local, or Tribal
Governments; Number of Respondents:
43; Total Annual Responses: 360; Total
Annual Hours: 9,360. (For policy
questions regarding this collection
contact Marybeth Ribar at 410–786–
1121. 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
E:\FR\FM\21OCN1.SGM
21OCN1
]]>Agencies
[Federal Register Volume 76, Number 204 (Friday, October 21, 2011)]
[Notices]
[Pages 65514-65515]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-27300]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10291 and CMS-10403]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
AGENCY: Centers for Medicare & Medicaid Services, HHS.
In compliance with the requirement of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the Centers for Medicare & Medicaid
Services (CMS), Department of Health and Human Services, is publishing
the following summary of proposed collections for public comment.
Interested persons are invited to send comments regarding this burden
estimate or any other aspect of this collection of information,
including any of the following subjects: (1) The necessity and utility
of the proposed information collection for the proper performance of
the Agency's function; (2) the accuracy of the estimated burden; (3)
ways to enhance the quality, utility, and clarity of the information to
be collected; and (4) the use of automated collection techniques or
other forms of information technology to minimize the information
collection burden.
1. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: State Collection
and Reporting of Dental Provider and Benefit Package Information on the
Insure Kids Now! Web site and Hotline; Use: The Children's Health
Insurance Program Reauthorization Act of 2009 (CHIPRA) sections
501(f)(1) and (2), requires that state-specific information on dental
providers and benefits be posted on the Insure Kids Now (IKN) Web site
and available on the hotline. States must update the information on the
dental providers quarterly and the information on their benefit package
annually. CMS is asking States to submit their dental benefits in a
revised format that is designed to reduce the amount of time States
have to spend in compiling the dental benefit information. Although in
the past we allowed States to only check a box to indicate that the
Medicaid dental benefits were in compliance with Early and Periodic
Screening, Diagnostic and Treatment (EPSDT) services, we are also
modifying the form to ask States to include their Medicaid dental
benefits in this form so those may also be posted on the Web site. In
addition, we are asking States to specify if they have a dollar or code
limit at which point prior authorization is required for any additional
services and if they have cost sharing requirements for dental
services; Form Number: CMS-10291 (OMB : 0938-1065); Frequency:
Yearly (dental benefits) and quarterly (dental providers); Affected
Public: State, Local, or Tribal Governments; Number of Respondents: 51;
Total Annual Responses: 255; Total Annual Hours: 190. (For policy
questions regarding this collection contact Nancy Goetschius at 410-
786-0707. For all other issues call 410-786-1326.)
2. Type of Information Collection Request: New collection; Title of
Information Collection: Community-
[[Page 65515]]
based Care Transitions Program (CCTP) Implementation and Monitoring;
Use: The Medicare Community-Based Care Transitions Program (CCTP),
authorized by Section 3026 of the 2010 Affordable Care Act, is a major
component of the Partnership for Patients initiative, one goal of which
is to decrease preventable complications during transition from a care
setting, such as a hospital, to home, community, or another care
setting. Appendix A contains a copy of the relevant portion of the
legislation.
The CCTP will provide funding to test models for improving care
transitions from the hospital to the community for high-risk Medicare
beneficiaries. The Centers for Medicare & Medicaid Services (CMS)
initiated the CCTP in early 2011 and will operate the program for five
years. Congress has authorized $500 million to cover the cost of the
program. CMS expects that program agreements will be in place to
authorize community-based organizations (CBOs), in partnership with
acute care hospitals, to begin providing care transition services in
November 2011 and, if successful, continue doing so for up to five
years. The planned collection of a participant experience survey is
part of the implementation and monitoring strategy that will review the
performance of organizations contracted to provide transitional care
services under the CCTP. This clearance package seeks approval for the
participant experience survey.
Form Number: CMS-10403 (OMB 0938-New); Frequency: Once;
Affected Public: Individuals or Households; Number of Respondents:
50,000; Total Annual Responses: 50,000; Total Annual Hours: 12,500.
(For policy questions regarding this collection contact Juliana
Tiongson at 410-786-0342. 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
E-mail 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 November 21,
2011.
OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk
Officer.
Fax Number: (202) 395-6974.
E-mail: OIRA_submission@omb.eop.gov.
Dated: October 18, 2011.
Martique Jones,
Director, Regulations Development Group, Division B, Office of
Strategic Operations and Regulatory Affairs.
[FR Doc. 2011-27300 Filed 10-20-11; 8:45 am]
BILLING CODE 4120-01-P
