Agency Information Collection Activities: Proposed Collection: Comment Request, 1214-1216 [2013-00031]

Download as PDF 1214 Federal Register / Vol. 78, No. 5 / Tuesday, January 8, 2013 / Notices Email address: OPREinfocollection@acf.hhs.gov. All requests should be identified by the title of the information collection. The Department specifically requests comments on (a) Whether the proposed collection of information is 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) 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. Consideration will be given to comments and suggestions submitted within 60 days of this publication. Steven M. Hammer, Reports Clearance Officer; Office of Planning, Research and Evaluation [FR Doc. 2012–31714 Filed 1–7–13; 8:45 am] BILLING CODE 4184–09–M DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Submission for OMB Review; Comment Request Title: Head Start Grant Application and Budget Instruments. OMB No.: 0970–0207. Description: The Office of Head Start is proposing to renew, without changes, the Head Start Grant Application and Budget Instrument, which standardizes the grant application information that is requested from all Head Start and Early Head Start grantees applying for continuation grants. The application and budget forms are available in a password-protected, web-based system. Completed applications can be transmitted electronically to Regional and Central Offices. The Administration for Children and Families believes that this application form makes the process of applying for Head Start program grants more efficient for applicants. Respondents: Head Start and Early Head Start grantees. Respondents ANNUAL BURDEN ESTIMATES Instrument Number of respondents Number of responses per respondent Average burden hours per response Total burden hours HS grant and budget instrument ..................................................................... 1,600 1 33 52,800 DEPARTMENT OF HEALTH AND HUMAN SERVICES Additional Information Copies of the proposed collection may be obtained by writing to the Administration for Children and Families, Office of Planning, Research and Evaluation, 370 L’Enfant Promenade, SW., Washington, DC 20447, Attn: ACF Reports Clearance Officer. All requests should be identified by the title of the information collection. Email address: infocollection@acf.hhs.gov. srobinson on DSK4SPTVN1PROD with Estimated Total Annual Burden Hours: 52,800. Health Resources and Services Administration OMB Comment OMB is required to make a decision concerning the collection of information between 30 and 60 days after publication of this document in the Federal Register. Therefore, a comment is best assured of having its full effect if OMB receives it within 30 days of publication. Written comments and recommendations for the proposed information collection should be sent directly to the following: Office of Management and Budget, Paperwork Reduction Project, Fax: 202–395–7285, Email: OIRA_SUBMISSION@OMB. EOP.GOV, Attn: Desk Officer for the Administration for Children and Families. Robert Sargis, Reports Clearance Officer. [FR Doc. 2013–00127 Filed 1–7–13; 8:45 am] BILLING CODE 4184–01–P VerDate Mar<15>2010 19:11 Jan 07, 2013 Jkt 229001 Agency Information Collection Activities: Proposed Collection: Comment Request ACTION: Notice. 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, email paperwork@hrsa.gov or call the HRSA Reports Clearance Officer at (301) 443– 1984. HRSA especially requests comments on: (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 SUMMARY: PO 00000 Frm 00019 Fmt 4703 Sfmt 4703 use of automated collection techniques or other forms of information technology to minimize the information collection burden. Information Collection Request Title: National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners—45 CFR Part 60 Regulations and Forms OMB No. 0915–0126—Revision Abstract: This is a request for a revision of OMB approval of the information collections contained in regulations found at 45 CFR Part 60 governing the National Practitioner Data Bank (NPDB) and the forms to be used in registering with, reporting information to, and requesting information from the NPDB. Section 6403 of the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act) Public Law 111–148 requires the transfer of all data in the Healthcare Integrity and Protection Data Bank (HIPDB) to the NPDB. Data collection will not change; however, the merger will consolidate forms from OMB No. 0915–0239 for HIPDB under OMB No. 0915–0126 for NPDB. Responsibility for NPDB implementation and operation resides in the Bureau of Health Professions, Health Resources and Services Administration (HRSA), Department of Health and Human Services (HHS). Operation of the HIPDB was delegated by the HHS Office of the Inspector General to HRSA. This rule E:\FR\FM\08JAN1.SGM 08JAN1 1215 Federal Register / Vol. 78, No. 5 / Tuesday, January 8, 2013 / Notices eliminates duplicative data reporting and access requirements between the HIPDB [established through the Health Insurance Portability and Accountability Act of 1996 (HIPPA) under Section 1128(b)(5) of the Social Security Act (42 U.S.C. 1320a–7e)] and the NPDB [established through the Health Care Quality Improvement Act of 1986 under Title IV (42 U.S.C. 11101 et seq.) and expanded by Section 1921 of the Social Security Act (42 U.S.C. 1396r–2)]. Information previously collected and disclosed through the HIPDB will be collected and disclosed through the NPDB. Section 6403 of the Affordable Care Act consolidates the collection and disclosure of information from both data banks under Title 45 part 60 of the Code of Federal Regulations (CFR). The Department of Health and Human Services (HHS) will subsequently remove Title 45 part 61, which implemented the HIPDB. The intent of NPDB is to improve the quality of health care by encouraging hospitals, state licensing boards, professional societies, and other entities providing health care services, to identify and discipline those who engage in unprofessional behavior; and to restrict the ability of incompetent health care practitioners, providers, or suppliers to move from state to state without disclosure of previous damaging or incompetent performance. It also serves as a fraud and abuse clearinghouse for the reporting and disclosing of certain final adverse actions (excluding settlements in which no findings of liability have been made) taken against health care practitioners, providers, or suppliers by health plans, federal agencies, and state agencies. The NPDB acts primarily as a flagging system; its principal purpose is to facilitate comprehensive review of practitioners’ professional credentials and background. Information is collected from, and disseminated to, eligible entities (entities that are entitled to query and/or report to the NPDB under the three aforementioned statutory authorities) on the following: (1) Medical malpractice payments, (2) licensure actions taken by Boards of Medical Examiners, (3) state licensure and certification actions, (4) federal licensure and certification actions, (5) negative actions or findings taken by peer review organizations or private accreditation entities, (6) adverse actions taken against clinical privileges, (7) federal or state criminal convictions related to the delivery of a health care item or service, (8) civil judgments related to the delivery of a health care item or service, (9) exclusions from participation in federal or state health care programs, and (10) other adjudicated actions or decisions. It is intended that NPDB information should Number of respondents Form name Number of responses per respondent be considered with other relevant information in evaluating credentials of health care practitioners, providers, and suppliers. The reporting forms and the request for information forms (query forms) are accessed, completed, and submitted to the NPDB electronically through the NPDB Web site at http://www.npdbhipdb.hrsa.gov/. All reporting and querying is performed through this secure Web site. Burden Statement: Burden in this context means the time expended by persons to generate, maintain, retain, disclose, or provide the information requested. This includes the time needed to review instructions, to develop, acquire, install and utilize technology and systems for the purpose of collecting, validating and verifying information, processing and maintaining information, and disclosing and providing information, to train personnel and to be able to respond to a collection of information, to search data sources, to complete and review the collection of information, and to transmit or otherwise disclose the information. The total annual burden hours estimated for this Information Collection Request are summarized in the table below. The annual estimate of burden is as follows: Total responses Average burden per response (in hours) Total burden hours 856 12,748 4,460,926 64,187 862 67 62,178 497 16,243 2,592 515 10 1,253 13,326 10 2055 20 83 276 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 856 12,748 4,460,926 64,187 862 67 62,178 497 16,243 2,592 515 10 1,253 13,326 10 2055 20 83 276 1 1 0.1 0.4 0.75 0.75 0.75 0.75 0.75 0.75 0.75 0.75 0.75 0.75 0.75 0.25 0.25 .25 0.25 856 12,748 446,093 25,675 647 50 46,634 373 12,182 1,944 386 8 940 9,995 8 514 5 21 69 100 1 100 1 100 TOTAL .......................................................................... srobinson on DSK4SPTVN1PROD with Entity Registration (initial) .................................................... Entity Registration (renewal) ................................................ Individual Subject Query ...................................................... Individual Self Query ............................................................ Title IV Clinical Privileges Action ......................................... Professional Society Membership Action ............................ State Licensure Action ......................................................... DEA/Federal Licensure Action ............................................. Exclusion/Debarment ........................................................... Government and Administrative Action ............................... Health Plan Action ............................................................... Civil Judgment ..................................................................... Criminal Conviction .............................................................. Medical Malpractice Payment .............................................. Private Accreditation Entity and Peer Review Organization Authorized Agent Designation Form (Add & Edit) ............... Account Discrepancy Report ............................................... Report Review Request Form ............................................. Electronic Transfer Funds Authorization ............................. Subject Statement and Dispute Initiation Form (Individual & Organization) ................................................................ 4,641,704 ........................ 4,641,704 ........................ 561,395 Submit your comments to paperwork@hrsa.gov or mail the HRSA Reports Clearance Officer, Room 10–29, ADDRESSES: VerDate Mar<15>2010 19:11 Jan 07, 2013 Jkt 229001 Parklawn Building, 5600 Fishers Lane, Rockville, MD 20857. PO 00000 Frm 00020 Fmt 4703 Sfmt 4703 Deadline: Comments on this Information Collection Request must be received within 60 days of this notice. E:\FR\FM\08JAN1.SGM 08JAN1 1216 Federal Register / Vol. 78, No. 5 / Tuesday, January 8, 2013 / Notices Dated: December 21, 2012. Bahar Niakan, Director, Division of Policy and Information Coordination. [FR Doc. 2013–00031 Filed 1–7–13; 8:45 am] BILLING CODE 4165–15–P DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Center for Scientific Review; Notice of Closed Meetings srobinson on DSK4SPTVN1PROD with Pursuant to section 10(d) of the Federal Advisory Committee Act, as amended (5 U.S.C. App.), notice is hereby given of the following meetings. The meetings will be closed to the public in accordance with the provisions set forth in sections 552b(c)(4) and 552b(c)(6), Title 5 U.S.C., as amended. The grant applications and the discussions could disclose confidential trade secrets or commercial property such as patentable material, and personal information concerning individuals associated with the grant applications, the disclosure of which would constitute a clearly unwarranted invasion of personal privacy. Name of Committee: Emerging Technologies and Training Neurosciences Integrated Review Group Bioengineering of Neuroscience, Vision and Low Vision Technologies Study Section. Date: February 7, 2013. Time: 8:00 a.m. to 6:00 p.m. Agenda: To review and evaluate grant applications. Place: Westin St. Francis Hotel, 335 Powell Street, San Francisco, CA 94102. Contact Person: Robert C Elliott, Ph.D., Scientific Review Officer, Center for Scientific Review, National Institutes of Health, 6701 Rockledge Drive, Room 5190, MSC 7846, Bethesda, MD 20892, 301–435– 3009, elliotro@csr.nih.gov. Name of Committee: Surgical Sciences, Biomedical Imaging and Bioengineering Integrated Review Group, Biomedical Imaging Technology A Study Section. Date: February 7–8, 2013. Time: 8:00 a.m. to 5:00 p.m. Agenda: To review and evaluate grant applications. Place: Serrano Hotel, 405 Taylor Street, San Francisco, CA 94102. Contact Person: Behrouz Shabestari, Ph.D., Scientific Review Officer, Center for Scientific Review, National Institutes of Health, 6701 Rockledge Drive, Room 5126, MSC 7854, Bethesda, MD 20892, (301) 435– 2409, shabestb@csr.nih.gov. Name of Committee: Endocrinology, Metabolism, Nutrition and Reproductive Sciences Integrated Review Group, Cellular Aspects of Diabetes and Obesity Study Section. Date: February 7, 2013. Time: 8:00 a.m. to 6:00 p.m. VerDate Mar<15>2010 19:11 Jan 07, 2013 Jkt 229001 Agenda: To review and evaluate grant applications. Place: Hyatt Regency Bethesda, One Bethesda Metro Center, 7400 Wisconsin Avenue, Bethesda, MD 20814. Contact Person: Robert Garofalo, Ph.D., Scientific Review Officer, Center for Scientific Review, National Institute of Health, 6701 Rockledge Drive, Room 6156, MSC 7892, Bethesda, MD 20892, 301–435– 1043, garofalors@csr.nih.gov. Name of Committee: Emerging Technologies and Training Neurosciences Integrated Review Group Neuroscience and Ophthalmic Imaging Technologies Study Section. Date: February 7, 2013. Time: 8:00 a.m. to 6:00 p.m. Agenda: To review and evaluate grant applications. Place: Renaissance Washington DC, Dupont Circle, 1143 New Hampshire Avenue NW., Washington, DC 20037. Contact Person: Yvonne Bennett, Ph.D., Scientific Review Officer, Center for Scientific Review, National Institutes of Health, 6701 Rockledge Drive, Room 5199, MSC 7846, Bethesda, MD 20892, 301–379– 3793, bennetty@csr.nih.gov. Name of Committee: Oncology 2— Translational Clinical Integrated Review Group Chemo/Dietary Prevention Study Section. Date: February 7–8, 2013. Time: 8:00 a.m. to 5:00 p.m. Agenda: To review and evaluate grant applications. Place: Sheraton Silver Spring, 8777 Georgia Avenue, Silver Spring, MD 20910. Contact Person: Sally A Mulhern, Ph.D., Scientific Review Officer, Center for Scientific Review, National Institutes of Health, 6701 Rockledge Drive, Room 6198, MSC 7804, Bethesda, MD 20892, (301) 408– 9724, mulherns@csr.nih.gov. Name of Committee: Interdisciplinary Molecular Sciences and Training Integrated Review Group Enabling Bioanalytical and Imaging Technologies Study Section. Date: February 7–8, 2013. Time: 8:00 a.m. to 6:00 p.m. Agenda: To review and evaluate grant applications. Place: Renaissance Mayflower Hotel, 1127 Connecticut Avenue NW., Washington, DC 20036. Contact Person: Dennis Hlasta, Ph.D., Scientific Review Officer, Center for Scientific Review, National Institutes of Health, 6701 Rockledge Drive, Room 6185, MSC, Bethesda, MD 20892, 301–435–1047, dennis.hlasta@nih.gov. Name of Committee: Endocrinology, Metabolism, Nutrition and Reproductive Sciences Integrated Review Group, Clinical and Integrative Diabetes and Obesity Study Section. Date: February 7, 2013. Time: 8:00 a.m. to 6:00 p.m. Agenda: To review and evaluate grant applications Place: Residence Inn Bethesda, 7335 Wisconsin Avenue, Bethesda, MD 20814. Contact Person: Nancy Sheard, SCD, Scientific Review Officer, Center for PO 00000 Frm 00021 Fmt 4703 Sfmt 4703 Scientific Review, National Institutes of Health, 6701 Rockledge Drive, Room 6046–E, MSC 7892, Bethesda, MD 20892, 301–408– 9901, sheardn@csr.nih.gov. (Catalogue of Federal Domestic Assistance Program Nos. 93.306, Comparative Medicine; 93.333, Clinical Research, 93.306, 93.333, 93.337, 93.393–93.396, 93.837–93.844, 93.846–93.878, 93.892, 93.893, National Institutes of Health, HHS) Dated: January 2, 2013. Anna Snouffer, Deputy Director, Office of Federal Advisory Committee Policy. [FR Doc. 2013–00088 Filed 1–7–13; 8:45 am] BILLING CODE 4140–01–P DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health Office of the Director, National Institutes of Health; Notice of Meeting Pursuant to section 10(a) of the Federal Advisory Committee Act, as amended (5 U.S.C. App.), notice is hereby given of a meeting of the Recombinant DNA Advisory Committee. The meeting will be open to the public, with attendance limited to space available. Individuals who plan to attend and need special assistance, such as sign language interpretation or other reasonable accommodations, should notify the Contact Person listed below in advance of the meeting. Name of Committee: Recombinant DNA Advisory Committee. Date: January 24, 2013. Time: 9:00 a.m. to 4:00 p.m. Agenda: The NIH Recombinant DNA Advisory Committee (RAC) will discuss Biosafety measures for research with highly pathogenic avian influenza H5N1 strains that have the potential to be transmissible through respiratory droplets and related data management activities. Please check the meeting agenda at OBA Meetings Page (available at the following URL: http:// oba.od.nih.gov/rdna_rac/rac_meetings.html) for more information. Place: National Institutes of Health, Building 45, Lower Level, Conference Room C1–C2, 45 Center Drive, Rockville, MD 20892. Contact Person: Chezelle George, Office of Biotechnology Activities, Office of Science Policy/OD, National Institutes of Health, 6705 Rockledge Drive, Room 750, Bethesda, MD 20892, 301–496–9838, georgec@od.nih.gov. Information is also available on the Institute’s/Center’s home page: http:// oba.od.nih.gov/rdna/rdna.html, where an agenda and any additional information for the meeting will be posted when available. OMB’s ‘‘Mandatory Information Requirements for Federal Assistance Program Announcements’’ (45 FR 39592, June 11, E:\FR\FM\08JAN1.SGM 08JAN1

Agencies

[Federal Register Volume 78, Number 5 (Tuesday, January 8, 2013)]
[Notices]
[Pages 1214-1216]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-00031]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Agency Information Collection Activities: Proposed Collection: 
Comment Request

ACTION: Notice.

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

SUMMARY: 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, email paperwork@hrsa.gov or 
call the HRSA Reports Clearance Officer at (301) 443-1984.
    HRSA especially requests comments on: (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.

Information Collection Request Title: National Practitioner Data Bank 
for Adverse Information on Physicians and Other Health Care 
Practitioners--45 CFR Part 60 Regulations and Forms OMB No. 0915-0126--
Revision

    Abstract: This is a request for a revision of OMB approval of the 
information collections contained in regulations found at 45 CFR Part 
60 governing the National Practitioner Data Bank (NPDB) and the forms 
to be used in registering with, reporting information to, and 
requesting information from the NPDB. Section 6403 of the Patient 
Protection and Affordable Care Act of 2010 (Affordable Care Act) Public 
Law 111-148 requires the transfer of all data in the Healthcare 
Integrity and Protection Data Bank (HIPDB) to the NPDB. Data collection 
will not change; however, the merger will consolidate forms from OMB 
No. 0915-0239 for HIPDB under OMB No. 0915-0126 for NPDB. 
Responsibility for NPDB implementation and operation resides in the 
Bureau of Health Professions, Health Resources and Services 
Administration (HRSA), Department of Health and Human Services (HHS). 
Operation of the HIPDB was delegated by the HHS Office of the Inspector 
General to HRSA. This rule

[[Page 1215]]

eliminates duplicative data reporting and access requirements between 
the HIPDB [established through the Health Insurance Portability and 
Accountability Act of 1996 (HIPPA) under Section 1128(b)(5) of the 
Social Security Act (42 U.S.C. 1320a-7e)] and the NPDB [established 
through the Health Care Quality Improvement Act of 1986 under Title IV 
(42 U.S.C. 11101 et seq.) and expanded by Section 1921 of the Social 
Security Act (42 U.S.C. 1396r-2)]. Information previously collected and 
disclosed through the HIPDB will be collected and disclosed through the 
NPDB. Section 6403 of the Affordable Care Act consolidates the 
collection and disclosure of information from both data banks under 
Title 45 part 60 of the Code of Federal Regulations (CFR). The 
Department of Health and Human Services (HHS) will subsequently remove 
Title 45 part 61, which implemented the HIPDB.
    The intent of NPDB is to improve the quality of health care by 
encouraging hospitals, state licensing boards, professional societies, 
and other entities providing health care services, to identify and 
discipline those who engage in unprofessional behavior; and to restrict 
the ability of incompetent health care practitioners, providers, or 
suppliers to move from state to state without disclosure of previous 
damaging or incompetent performance. It also serves as a fraud and 
abuse clearinghouse for the reporting and disclosing of certain final 
adverse actions (excluding settlements in which no findings of 
liability have been made) taken against health care practitioners, 
providers, or suppliers by health plans, federal agencies, and state 
agencies.
    The NPDB acts primarily as a flagging system; its principal purpose 
is to facilitate comprehensive review of practitioners' professional 
credentials and background. Information is collected from, and 
disseminated to, eligible entities (entities that are entitled to query 
and/or report to the NPDB under the three aforementioned statutory 
authorities) on the following: (1) Medical malpractice payments, (2) 
licensure actions taken by Boards of Medical Examiners, (3) state 
licensure and certification actions, (4) federal licensure and 
certification actions, (5) negative actions or findings taken by peer 
review organizations or private accreditation entities, (6) adverse 
actions taken against clinical privileges, (7) federal or state 
criminal convictions related to the delivery of a health care item or 
service, (8) civil judgments related to the delivery of a health care 
item or service, (9) exclusions from participation in federal or state 
health care programs, and (10) other adjudicated actions or decisions. 
It is intended that NPDB information should be considered with other 
relevant information in evaluating credentials of health care 
practitioners, providers, and suppliers.
    The reporting forms and the request for information forms (query 
forms) are accessed, completed, and submitted to the NPDB 
electronically through the NPDB Web site at http://www.npdb-hipdb.hrsa.gov/. All reporting and querying is performed through this 
secure Web site.
    Burden Statement: Burden in this context means the time expended by 
persons to generate, maintain, retain, disclose, or provide the 
information requested. This includes the time needed to review 
instructions, to develop, acquire, install and utilize technology and 
systems for the purpose of collecting, validating and verifying 
information, processing and maintaining information, and disclosing and 
providing information, to train personnel and to be able to respond to 
a collection of information, to search data sources, to complete and 
review the collection of information, and to transmit or otherwise 
disclose the information. The total annual burden hours estimated for 
this Information Collection Request are summarized in the table below.
    The annual estimate of burden is as follows:

----------------------------------------------------------------------------------------------------------------
                                                     Number of                    Average burden
            Form name                Number of     responses per       Total       per response    Total burden
                                    respondents     respondent       responses      (in hours)         hours
----------------------------------------------------------------------------------------------------------------
Entity Registration (initial)...             856               1             856               1             856
Entity Registration (renewal)...          12,748               1          12,748               1          12,748
Individual Subject Query........       4,460,926               1       4,460,926             0.1         446,093
Individual Self Query...........          64,187               1          64,187             0.4          25,675
Title IV Clinical Privileges                 862               1             862            0.75             647
 Action.........................
Professional Society Membership               67               1              67            0.75              50
 Action.........................
State Licensure Action..........          62,178               1          62,178            0.75          46,634
DEA/Federal Licensure Action....             497               1             497            0.75             373
Exclusion/Debarment.............          16,243               1          16,243            0.75          12,182
Government and Administrative              2,592               1           2,592            0.75           1,944
 Action.........................
Health Plan Action..............             515               1             515            0.75             386
Civil Judgment..................              10               1              10            0.75               8
Criminal Conviction.............           1,253               1           1,253            0.75             940
Medical Malpractice Payment.....          13,326               1          13,326            0.75           9,995
Private Accreditation Entity and              10               1              10            0.75               8
 Peer Review Organization.......
Authorized Agent Designation                2055               1            2055            0.25             514
 Form (Add & Edit)..............
Account Discrepancy Report......              20               1              20            0.25               5
Report Review Request Form......              83               1              83             .25              21
Electronic Transfer Funds                    276               1             276            0.25              69
 Authorization..................
Subject Statement and Dispute                100               1             100               1             100
 Initiation Form (Individual &
 Organization)..................
                                 -------------------------------------------------------------------------------
    TOTAL.......................       4,641,704  ..............       4,641,704  ..............         561,395
----------------------------------------------------------------------------------------------------------------


ADDRESSES: Submit your comments to paperwork@hrsa.gov or mail the HRSA 
Reports Clearance Officer, Room 10-29, Parklawn Building, 5600 Fishers 
Lane, Rockville, MD 20857.
    Deadline: Comments on this Information Collection Request must be 
received within 60 days of this notice.


[[Page 1216]]


    Dated: December 21, 2012.
Bahar Niakan,
Director, Division of Policy and Information Coordination.
[FR Doc. 2013-00031 Filed 1-7-13; 8:45 am]
BILLING CODE 4165-15-P