Agency Information Collection: Emergency Submission for OMB Review (PACT Demo Lab, Clinical Innovation Study: Implementation of a Patient Centered Medical Home for OEF/OIF Veterans With PTSD: Bridging Primary and Behavioral Health Care); Comment Request, 51849-51850 [2012-20916]
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pmangrum on DSK3VPTVN1PROD with NOTICES
Federal Register / Vol. 77, No. 166 / Monday, August 27, 2012 / Notices
received into any of our dockets by the
name of the individual submitting the
comment (or signing the comment, if
submitted on behalf of an association,
business, labor union, etc.). Therefore,
you may want to review DOT’s
complete Privacy Act Statement in the
Federal Register published on April 11,
2000 (65 FR 19477) or visit https://www.
regulations.gov before submitting any
such comments.
Docket: For access to the docket or to
read background documents or
comments, go to https://www.
regulations.gov at any time or to Room
W12–140 on the ground level of DOT,
West Building, 1200 New Jersey Avenue
SE., Washington, DC, between 9 a.m.
and 5 p.m., Monday through Friday,
except Federal holidays. If you wish to
receive confirmation of receipt of your
written comments, please include a selfaddressed, stamped postcard with the
following statement: ‘‘Comments on
PHMSA–2012–0215.’’ The Docket Clerk
will date stamp the postcard prior to
returning it to you via the U.S. mail.
Please note that due to delays in the
delivery of U.S. mail to Federal offices
in Washington, DC, we recommend that
persons consider an alternative method
(internet, fax, or professional delivery
service) of submitting comments to the
docket and ensuring their timely receipt
at DOT.
FOR FURTHER INFORMATION CONTACT:
Angela Dow by telephone at 202–366–
1246, by fax at 202–366–4566, or by
mail at DOT, PHMSA, 1200 New Jersey
Avenue SE., PHP–30, Washington, DC
20590–0001.
SUPPLEMENTARY INFORMATION: Section
1320.8(d), Title 5, Code of Federal
Regulations, requires PHMSA to provide
interested members of the public and
affected agencies an opportunity to
comment on information collection and
recordkeeping requests. This notice
identifies an information collection
request that PHMSA will be submitting
to OMB for renewal. The following
information is provided for that
information collection: (1) Title of the
information collection; (2) OMB control
number; (3) Current expiration date; (4)
Type of request; (5) Abstract of the
information collection activity; (6)
Description of affected public; (7)
Estimate of total annual reporting and
recordkeeping burden; and (8)
Frequency of collection. PHMSA will
request a three-year term of approval for
the information collection activity.
PHMSA requests comments on the
following information collections:
Title: Pipeline Safety: Control Room
Management/Human Factors.
OMB Control Number: 2137–0624.
VerDate Mar<15>2010
15:04 Aug 24, 2012
Jkt 226001
Current Expiration Date: 1/31/2013.
Abstract: 49 CFR 192.631 and 195.446
address human factors and other
components of control room
management. These regulations require
operators of hazardous liquid pipelines
and gas pipelines to develop and
implement a human factors
management plan designed to reduce
risk associated with human factors in
each control room.
Affected Public: Private sector;
Operators of both natural gas and
hazardous liquid pipeline systems.
Annual Reporting and Recordkeeping
Burden:
Total Annual Responses: 2,702.
Total Annual Burden Hours:
1,018,807.
Frequency of Collection: On
Occasion.
Title: Integrity Management Program
for Gas Distribution Pipelines.
OMB Control Number: 2137–0625.
Current Expiration Date: 1/31/2013.
Abstract: The Federal Pipeline Safety
Regulations in 49 CFR, Part 192,
Subpart P require operators of gas
distribution pipelines to develop and
implement integrity management (IM)
programs. The purpose of these
programs is to enhance safety by
identifying and reducing pipeline
integrity risks. PHMSA requires that
operators maintain records
demonstrating compliance with these
requirements for 10 years, and that these
records must include superseded IM
plans.
Affected Public: Operators of gas
distribution pipeline systems.
Annual Reporting and Recordkeeping
Burden:
Total Annual Responses: 9,343.
Total Annual Burden Hours: 865,178.
Frequency of Collection: On occasion.
Comments are invited on:
(a) The need for the proposed
collection of information for the proper
performance of the functions of the
agency, including whether the
information will have practical utility;
(b) The accuracy of the agency’s
estimate of the burden of the proposed
collection of information, including the
validity of the methodology and
assumptions used;
(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 those
who are to respond, including the use
of appropriate automated, electronic,
mechanical, or other technological
collection techniques.
PO 00000
Frm 00102
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51849
Issued in Washington, DC, on August 21,
2012.
John A. Gale,
Director, Office of Standards and
Rulemaking.
[FR Doc. 2012–20935 Filed 8–24–12; 8:45 am]
BILLING CODE 4910–60–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900-New (VA Form 10–
0529a–f)]
Agency Information Collection:
Emergency Submission for OMB
Review (PACT Demo Lab, Clinical
Innovation Study: Implementation of a
Patient Centered Medical Home for
OEF/OIF Veterans With PTSD: Bridging
Primary and Behavioral Health Care);
Comment Request
Veterans Health
Administration, Department of Veterans
Affairs.
ACTION: Notice.
AGENCY:
In compliance with the
Paperwork Reduction Act (PRA) of 1995
(44 U.S.C., 3501–3521), this notice
announces that the Department of
Veterans Affairs (VA), will submit to the
Office of Management and Budget
(OMB) the following emergency
proposal for the collection of
information under the provisions of the
Paperwork Reduction Act (44 U.S.C.
3507(j)(1)). An emergency clearance is
being requested for information needed
to develop and evaluate a patientcentered model of care for OEF/OIF
veterans with PTSD.
DATES: Comments must be submitted on
or before September 6, 2012.
ADDRESSES: Send comments and
recommendations concerning any
aspect of the information collection to
VA’s OMB Desk Officer, OMB Human
Resources and Housing Branch, New
Executive Office Building, Room 10235,
Washington, DC 20503 (202) 395–7316
or FAX (202) 395–6974. Please refer to
‘‘2900–New (VA Form 10–0529a–f).
FOR FURTHER INFORMATION CONTACT:
Denise McLamb, Enterprise Records
Service (005R1B), Department of
Veterans Affairs, 810 Vermont Avenue
NW, Washington, DC 20420, (202) 632–
7479, Fax (202) 632–7583 or email:
denise.mclamb@va.gov. Please refer to
‘‘OMB Control No. 2900-New VA Form
(10–0529a–f).
SUPPLEMENTARY INFORMATION:
Titles: PACT Demo Lab, Clinical
Innovation Study: Implementation of a
Patient Centered Medical Home for
SUMMARY:
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51850
Federal Register / Vol. 77, No. 166 / Monday, August 27, 2012 / Notices
OEF/OIF Veterans with PTSD: Bridging
Primary and Behavioral Health Care.
a. SF 12, Questionnaire, VA Form 10–
0529.
b. (Patient Health Questionnaire-9
(PHQ–9), VA Form 10–0529a.
c. PTSD Checklist (PCL), VA Form
10–0529Bb.
d. Patient Satisfaction QuestionnaireShort Form (PSQ–18), VA Form 10–
0529c.
e. Combat Exposure Scale (CES), VA
Form 10–0529d.
f. World Health Organization Quality
of Life (WHOQOL–BREF), VA Form 10–
0529e.
g. World Health Organization
Disability Assessment Schedule II
(WHODAS–II), VA Form 10–0529f.
OMB Control Number: 2900-New.
Type of Review: New data collection.
The data collected on VA Forms 10–
0529a–f will be used to develop and
evaluate a patient-centered model of
care for OEF/OIF Veterans with PTSD.
The forms will be used to survey the
effectiveness of the patient centered
medical home model by enhancing the
conventional care currently provided in
the care of patients with PTSD.
Affected Public: Individuals or
households.
Estimated Annual Burden: 420.
Frequency of Response: Annually.
Estimated Average Burden per
Respondent: 10 minutes.
Estimated Number of Respondents:
840.
Estimated Number of Responses:
2,520.
Dated: August 21, 2012.
By direction of the Secretary.
Denise McLamb,
Program Analyst Director, Enterprise Records
Service.
[FR Doc. 2012–20916 Filed 8–24–12; 8:45 am]
BILLING CODE 8320–01–P
DEPARTMENT OF VETERANS
AFFAIRS
[OMB Control No. 2900-New (VA Form 10–
0532a–k)]
pmangrum on DSK3VPTVN1PROD with NOTICES
Agency Information Collection:
Emergency Submission for OMB
Review (PACT: Clinical Innovation
Study—Helping Veterans Manage
Chronic Pain); Comment Request
Veterans Health
Administration, Department of Veterans
Affairs.
ACTION: Notice.
AGENCY:
In compliance with the
Paperwork Reduction Act (PRA) of 1995
(44 U.S.C., 3501–3521), this notice
SUMMARY:
VerDate Mar<15>2010
15:04 Aug 24, 2012
Jkt 226001
announces that the Department of
Veterans Affairs (VA), will submit to the
Office of Management and Budget
(OMB) the following emergency
proposal for the collection of
information under the provisions of the
Paperwork Reduction Act (44 U.S.C.
3507(j)(1)). An emergency clearance is
being requested for information needed
to assess the effectiveness of pain care
management provided to veterans.
DATES: Comments must be submitted on
or before September 6, 2012.
ADDRESSES: Send comments and
recommendations concerning any
aspect of the information collection to
VA’s OMB Desk Officer, OMB Human
Resources and Housing Branch, New
Executive Office Building, Room 10235,
Washington, DC 20503 (202) 395–7316
or FAX (202) 395–6974. Please refer to
‘‘2900–New (VA Form 10–0532a–k).
FOR FURTHER INFORMATION CONTACT:
Denise McLamb, Enterprise Records
Service (005R1B), Department of
Veterans Affairs, 810 Vermont Avenue
NW, Washington, DC 20420, (202) 632–
7479, FAX (202) 632–7583 or email:
denise.mclamb@va.gov. Please refer to
‘‘OMB Control No. 2900-New (VA Form
10–0532a–k).
SUPPLEMENTARY INFORMATION:
Titles: Clinical Innovation Study—
Helping Veterans Manage Chronic
Pain
a. Pain Care Management Tracking
Tool, VA Form 10–0532.
b. Pain Care Management Self
Monitoring Form (unpublished),
VA Form 10–0532a.
c. Pain Outcomes Questionnaire
(Clark, Gironda, & Young, 2003),
VA Form 10–0532b.
d. The Multidimensional Pain
Inventory (MPI; Kearns, Turk, &
Rudy, 1985), VA Form 10–0532c.
e. Pain Catastrophizing Scale (Osman,
Barrios, Gutierrez, Kopper,
Merrifield, & Grittmann, 2000), VA
Form 10–0532d.
f. The Oswestry Disability Index
(Fairbank & Pynsent, 2000), VA
Form 10–0532e.
g. Brief Pain Inventory—Short Form
(BPI; Cleeland, 1991). Administered
at baseline and each follow-up, VA
Form 10–0532f.
h. Fear-Avoidance Beliefs
Questionnaire (FABQ; Waddell,
Newton, et al., 1993), VA Form 10–
0532g.
i. The Brief COPE (Carver, 1997), VA
Form 10–0532h.
j. Depression and Anxiety Stress
Scales (DASS–21; Lovibond &
Lovibond, 1995), VA Form 10–
0532i.
k. Patient Health Questionnaire
PO 00000
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Fmt 4703
Sfmt 4703
(PHQ–9; Kroenke, Spitzer, &
Williams, 2001), VA Form 10–
0532j.
l. Generalized Anxiety Disorder
(GAD–7); Spitzer, Kroenke,
Williams, & Lowe, 2006), VA Form
10–0532k.
OMB Control Number: 2900-New.
Type of Review: New data collection.
Abstract: The data collected on VA
Form 10–0532a–k will be used to: (1)
Assess the effectiveness of patient care
management (PCM) in increasing
patients’ functionality, improving
quality of life, and improving pain
control relative to usual care and (2) to
assess the impact of PCM on depression
and anxiety relative to usual care. This
data collection’s model has been
designed to serve patients by
augmenting existing pain management
interventions (e.g., medications,
physical therapy) by teaching pain care
management skills that patients can
incorporate into their daily activities.
VA will use the information to evaluate
the effectiveness of the intervention so
that it can most effectively be applied to
future patients with chronic pain
problems.
Affected Public: Individuals or
households.
Estimated Annual Burden
a. VA Form 10–0532—67 hours.
b. VA Form 10–0532a—80 hours.
c. VA Form 10–0532b—200 hours.
d. VA Form 10–0532c—80 hours.
e. VA Form 10–0532d—53 hours.
f. VA Form 10–0532e—53 hours.
g. VA Form 10–0532f—133 hours.
h. VA Form 10–0532g—19 hours.
i. VA Form 10–0532h—27 hours.
j. VA Form 10–0532i—93 hours.
k. VA Form 10–0532j— 67 hours.
l. VA Form 10–0532k—67 hours.
Estimated Average Burden per
Respondent
a. VA Form 10–0532—5 minutes.
b. VA Form 10–0532a—10 minutes.
c. VA Form 10–0532b—15 minutes.
d. VA Form 10–0532c—15 minutes.
e. VA Form 10–0532d—10 minutes.
f. VA Form 10–0532e—10 minutes.
g. VA Form 10–0532f—10 minutes.
h. VA Form 10–0532g—7 minutes.
i. VA Form 10–0532h—10 minutes.
j. VA Form 10–0532i—7 minutes.
k. VA Form 10–0532j—5 minutes.
l. VA Form 10–0532k—5 minutes.
Frequency of Response: Monthly.
Estimated Number of Respondents
a. VA Form 10–0532—800.
b. VA Form 10–0532a—480.
c. VA Form 10–0532b—800.
d. VA Form 10–0532c—320.
e. VA Form 10–0532d—320.
f. VA Form 10–0532e—320.
g. VA Form 10–0532f—800.
E:\FR\FM\27AUN1.SGM
27AUN1
]]>Agencies
[Federal Register Volume 77, Number 166 (Monday, August 27, 2012)]
[Notices]
[Pages 51849-51850]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-20916]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
[OMB Control No. 2900-New (VA Form 10-0529a-f)]
Agency Information Collection: Emergency Submission for OMB
Review (PACT Demo Lab, Clinical Innovation Study: Implementation of a
Patient Centered Medical Home for OEF/OIF Veterans With PTSD: Bridging
Primary and Behavioral Health Care); Comment Request
AGENCY: Veterans Health Administration, Department of Veterans Affairs.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995
(44 U.S.C., 3501-3521), this notice announces that the Department of
Veterans Affairs (VA), will submit to the Office of Management and
Budget (OMB) the following emergency proposal for the collection of
information under the provisions of the Paperwork Reduction Act (44
U.S.C. 3507(j)(1)). An emergency clearance is being requested for
information needed to develop and evaluate a patient-centered model of
care for OEF/OIF veterans with PTSD.
DATES: Comments must be submitted on or before September 6, 2012.
ADDRESSES: Send comments and recommendations concerning any aspect of
the information collection to VA's OMB Desk Officer, OMB Human
Resources and Housing Branch, New Executive Office Building, Room
10235, Washington, DC 20503 (202) 395-7316 or FAX (202) 395-6974.
Please refer to ``2900-New (VA Form 10-0529a-f).
FOR FURTHER INFORMATION CONTACT: Denise McLamb, Enterprise Records
Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue
NW, Washington, DC 20420, (202) 632-7479, Fax (202) 632-7583 or email:
denise.mclamb@va.gov. Please refer to ``OMB Control No. 2900-New VA
Form (10-0529a-f).
SUPPLEMENTARY INFORMATION:
Titles: PACT Demo Lab, Clinical Innovation Study: Implementation of
a Patient Centered Medical Home for
[[Page 51850]]
OEF/OIF Veterans with PTSD: Bridging Primary and Behavioral Health
Care.
a. SF 12, Questionnaire, VA Form 10-0529.
b. (Patient Health Questionnaire-9 (PHQ-9), VA Form 10-0529a.
c. PTSD Checklist (PCL), VA Form 10-0529Bb.
d. Patient Satisfaction Questionnaire- Short Form (PSQ-18), VA Form
10-0529c.
e. Combat Exposure Scale (CES), VA Form 10-0529d.
f. World Health Organization Quality of Life (WHOQOL-BREF), VA Form
10-0529e.
g. World Health Organization Disability Assessment Schedule II
(WHODAS-II), VA Form 10-0529f.
OMB Control Number: 2900-New.
Type of Review: New data collection.
The data collected on VA Forms 10-0529a-f will be used to develop
and evaluate a patient-centered model of care for OEF/OIF Veterans with
PTSD. The forms will be used to survey the effectiveness of the patient
centered medical home model by enhancing the conventional care
currently provided in the care of patients with PTSD.
Affected Public: Individuals or households.
Estimated Annual Burden: 420.
Frequency of Response: Annually.
Estimated Average Burden per Respondent: 10 minutes.
Estimated Number of Respondents: 840.
Estimated Number of Responses: 2,520.
Dated: August 21, 2012.
By direction of the Secretary.
Denise McLamb,
Program Analyst Director, Enterprise Records Service.
[FR Doc. 2012-20916 Filed 8-24-12; 8:45 am]
BILLING CODE 8320-01-P
