Agency Information Collection Activities: Submission for Office of Management and Budget (OMB) Review; Comment Request, 42091-42099 [2013-16794]
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42091
Federal Register / Vol. 78, No. 135 / Monday, July 15, 2013 / Notices
instruments must be requested in
writing.
Proposed Collection: NIH Office of
Intramural Training & Education
Application, 0925–0299 Revision, Office
of the Director (OD), National Institutes
of Health (NIH).
Need and Use of Information
Collection: The Office of Intramural
Training & Education (OITE)
administers a variety of programs and
initiatives to recruit pre-college through
post-doctoral educational level
individuals into the National Institutes
of Health Intramural Research Program
(NIH–IRP) to facilitate develop into
future biomedical scientists. The
proposed information collection is
necessary in order to determine the
eligibility and quality of potential
awardees for traineeships in these
programs. The applications for
admission consideration include key
areas such as: Personal information,
eligibility criteria, contact information,
student identification number, training
program selection, scientific discipline
interests, educational history,
standardized examination scores,
reference information, resume
components, employment history,
employment interests, dissertation
research details, letters of
recommendation, financial aid history,
sensitive data, future networking
contact, travel information, as well as
feedback questions about interviews and
application submission experiences.
Sensitive data collected on the
applicants, race, gender, ethnicity,
disability, and recruitment method, are
made available only to OITE staff
members or in aggregate form to select
NIH offices and are not used by the
admission committee for admission
consideration; optional to submit.
OMB approval is requested for 3
years. There are no costs to respondents
other than their time. The total
estimated annualized burden hours are
18,354.00.
ESTIMATED ANNUALIZED BURDEN HOURS
Estimated
number of
respondents
Type of respondent
Summer Internship Program in Biomedical Research (SIP) ...........................
Biomedical Engineering Summer Internship Program (BESIP) ......................
Post-baccalaureate Training Program (PBT) ..................................................
Community College Summer Enrichment Program (CCSEP) ........................
Technical Training Program (PBT) ..................................................................
Graduate Partnerships Program (GPP)—Application (Select Institutional
Partnerships) ................................................................................................
Graduate Partnerships Program (GPP)—Registration (Select Institutional
Partnerships + Individual Partnership) .........................................................
National Graduate Student Research Conference (NGSRC) .........................
Undergraduate Scholarship Program (UGSP) ................................................
Alumni Database .............................................................................................
UGSP—Certificate of Eligibility (Completed by Applicant) ..............................
UGSP—Certificate of Eligibility (Completed by University Staff) ....................
UGSP—Deferment Form (Completed by Applicant) .......................................
UGSP—Deferment Form (Completed by University Staff) .............................
Reference Recommendation Letters for All Programs ....................................
Survey—Race-Ethnicity-Gender-Birth Year (25% Response Rate) ................
Survey—Time to Complete Application Form (4% Response Rate) ..............
Survey—GPP Interview Experience (60% Response Rate) ...........................
Totals ........................................................................................................
Dated: July 1, 2013.
Richard Wyatt,
Executive Director, Office of Intramural
Research, OD, National Institutes of Health.
[FR Doc. 2013–16887 Filed 7–12–13; 8:45 am]
BILLING CODE 4140–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
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National Cancer Institute; Amended
Notice of Meeting
1.0
1.0
1.0
1.0
1.0
6,820.00
80.00
1,885.00
100.00
115.00
250.0
1.0
1.0
250.00
140.0
800.0
200.0
1,900.0
200.0
200.0
40.0
40.0
23,235.0
3,073.0
492.0
30.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
3/60
15/60
3/60
15/60
15/60
3/60
3/60
10/60
140.00
800.00
200.00
1,900.00
10.00
50.00
2.00
10.00
5,808.75
153.65
24.60
5.0
39,600.0
N/A
N/A
18,354.00
20850 which was published in the
Federal Register on June 17, 2013,
78FR36201.
This notice is being amended to
change the meeting format from a face
to face meeting to a teleconference. Also
the meeting date and time are now 10:30
a.m. to 12:00 p.m. on August 12, 2013.
The meeting is closed to the public.
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18:53 Jul 12, 2013
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BILLING CODE 4140–01–P
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Estimated total
annual burden
hours
1.0
1.0
1.0
1.0
1.0
[FR Doc. 2013–16791 Filed 7–12–13; 8:45 am]
Notice is hereby given of a change in
the meeting of the National Cancer
Institute Special Emphasis Panel, July
30, 2013, 9:00 a.m.–4:00 p.m., National
Cancer Institute, 9609 Medical Center
Drive, Room 2W908 Rockville, MD,
Estimated total
annual burden
hours
6,820.0
80.0
1,885.0
100.0
115.0
Dated: July 9, 2013.
David Clary,
Program Analyst, Office of Federal Advisory
Committee Policy.
National Institutes of Health
Estimated
number of
responses
annually per
respondent
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Substance Abuse and Mental Health
Services Administration
Agency Information Collection
Activities: Submission for Office of
Management and Budget (OMB)
Review; Comment Request
Periodically, the Substance Abuse and
Mental Health Services Administration
(SAMHSA) will publish a summary of
information collection requests under
OMB review, in compliance with the
Government Paperwork Elimination Act
(GPEA) 44 U.S.C. 3504. To request a
copy of these documents, call the
SAMHSA Reports Clearance Officer at
(240) 276–1243.
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Federal Register / Vol. 78, No. 135 / Monday, July 15, 2013 / Notices
Project: Mandatory Guidelines for
Federal Workplace Drug Testing
Programs (OMB No. 0930–0158)—
Revision
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SAMHSA will request OMB approval
for the Federal Drug Testing Custody
and Control Form (Federal CCF) for
federal agency and federally regulated
drug testing programs which must
comply with the HHS Mandatory
Guidelines for Federal Workplace Drug
Testing Programs (73 FR 71858) dated
November 25, 2008, and OMB approval
for the information provided by test
facilities (i.e., laboratories and
Instrumented Initial Test Facilities,
IITFs) for the National Laboratory
Certification Program (NLCP).
The Federal CCF is used by all federal
agencies and employers regulated by the
Department of Transportation (DOT) to
document the collection and chain of
custody of drug testing specimens at the
collection site, for the test facility to
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18:53 Jul 12, 2013
Jkt 229001
report results, and for the Medical
Review Officer (MRO) to make a
determination. The current OMBapproved Federal CCF has an August
31, 2013 expiration date. In accordance
with the GPEA, OMB set terms of
clearance for the extension of the
current Federal CCF as follows: Prior to
the next approval of this package, the
Agency (SAMHSA) shall provide a
progress update on adoption of
electronic forms in an effort to reduce
burden. SAMHSA is encouraged to
explore ways to convert the Federal
Drug Testing Custody and Control Form
(Federal CCF) into an electronic form.
In an effort to comply with the stated
terms of the clearance requirement set
forth by OMB, SAMHSA will authorize
the use of an electronic Federal CCF.
SAMHSA has resubmitted the Federal
CCF with no content revisions to the
form for OMB approval. The only
revisions are to enable the form to be
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used as a paper form or as an electronic
form.
• The first change to the Federal CCF
is to allow the Public Burden Statement
to be a separate page of an electronic
Federal CCF. The Public Burden
Statement must appear on all federal
government forms that place a reporting
burden on gathering information.
• The second change is to allow the
Federal CCF instructions and the
Privacy Act Statement to be on a
separate page or pages of an electronic
Federal CCF.
• The third change is to allow the
bottle labels/seals to be printed
separately, and not as a part of Copy 1
of the Federal CCF.
• The fourth change is to revise the
Federal CCF Instructions to allow the
use of an electronic form.
Below is a copy of the Federal CCF:
BILLING CODE 4162–20–P
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Federal Register / Vol. 78, No. 135 / Monday, July 15, 2013 / Notices
FEDERAL DRUG TESTING CUSTODY AND CONTROL FORM
1111111111111111111111111111111
0000001
SPECIMEN 10 NO.
STEP 1: COMPLETED ElY COLLECTOR OR EMPLOYER REPRESENTATIVE
A. Emplo)l!>f Name, Address, J.D. No.
ACCESSION NO.
EI. MRO Name, Address, Phone Nth and Fax No.
C.oooorSSNor EmplO)l!>e 1.0.• _. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
o
NRC
DOT - Specify DOT Agency: 0 FMCSA 0 FAA 0 FAA 0 ITA 0 PHMSA 0 USCG
E. R_onlor Tesl: 0 l're-llfllll!oylMRI 0 Random 0 RU$llnllblG Suspll::iooJCausG 0 Post Accident 0 R~lurn 10 !luly 0 FoIOOl4.Jp 0 OthGf (specilyl ______
F; Drug Tesls to be peflormad:
0 THC, COC, pcp, 01"1, AMP 0 THC & COC Only 0 Otoor (specify) _ _ _ _ _ _ _ _ _ _ _ _ __
D. Sprelly Testing AUl!lorny.
G. Collection Site Addmss:
Collector Phona No. _ _ _ _ _ _ _ _ _ _ __
RECEIVED AT IITF:
X
DMDMA
o DILUTE
o REJECTED FOR TESTING
REMARK~
o ADULTERATED
o SUBSTITUTED
o INVALID RESULT
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
STEP 5B: COMPLETED BY SPLlTTESTlNG LABORATORY
o SPLIT SPECIMEN TESTED; SEE LABORATORY REPORT
0000001
A
SPECIMEN BOTTLE
SEAL
0000001
B
tkelley on DSK3SPTVN1PROD with NOTICES
SP!;CI~AEN
ID NO.
Paper CCF: Back of Copy 1–4
Electronic CCF: Separate Page
Public Burden Statement
Public Burden Statement: An agency
may not conduct or sponsor, and a
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18:53 Jul 12, 2013
Jkt 229001
person is not required to respond to, a
collection of information unless it
displays a currently valid OMB control
number. The OMB control number for
this project is 0930–0158. Public
reporting burden for this collection of
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information is estimated to average: 5
minutes/donor; 4 minutes/collector; 3
minutes/test facility; and 3 minutes/
Medical Review Officer. Send
comments regarding this burden
estimate or any other aspect of this
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EN15JY13.000
SPECIMEN BOTTLE
SEAL
(SPuT)
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Federal Register / Vol. 78, No. 135 / Monday, July 15, 2013 / Notices
collection of information, including
suggestions for reducing this burden, to
SAMHSA Reports Clearance Officer,
1 Choke Cherry Road, Room 2–1057,
Rockville, Maryland, 20857.
FEDERAL DRUG TESTING CUSTODY AND CONTROL FORM
SPl'iCIMEN ID NO.
C. Dooor SSN '" Empklye" til
D. Specify Tem".,,, 1wII>",ity: 0 HHS
E. A"""",n fi:Jr Teol:
0
~aymn"l': 0 !'MCSA 0 FAA 0 FAA 0 FTA 0 PHMSA 0 USCG
R""o.m 0 !'te.o""".bl" 5I1Op.,i""/(;""",, 0 Pool Accident 0 Rolum to Duly 0 FaU".,-up 0 Other (JIjl'oi[y) _ _ _ _ __
THe, CQC, PCF\ CPI, AMP
0 THe &. CDC Only 0 0100, (spe F"'*-i ..quir"""",1l!, my ~Iiof _ _ _ 'wOflicor
tI'!IIIIITl_"'" _0IIIt:0<._1Rr0l, ilL L••ll
-
~v...Iiif~
STEP 1: COMPLETED BY MEDICAL REVIEW OFFICER SPLIT SPECIMEN
In """orda""" ..,til app/ioab!<> F~I "'~!1Il!, my ~Iioo for Ill" opiil spoofmen (ff 1ss1«l) ill:
o RECONFIRMED tor:
o FAILED 10 RECONFIRM tor:
""' ""''''''',
D TEST CANCELLED
X
VerDate Mar<15>2010
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~~OlMOOi_~w~
18:53 Jul 12, 2013
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.
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Federal Register / Vol. 78, No. 135 / Monday, July 15, 2013 / Notices
FEDERAL DRUG TESTING CUSTODY AND CONTROL FORM
0000001
SPECIMEN ID NO~
STEP 1: COMPLETED BY COLLECTOR OR EMPLOYER REPRESENTATIVE
ACCESSION NO.
c, 0000' SSN .oifyl ______
IF Drug rei'll" to be Pe"orrrn;d:
0 THe, cae, pcp, OPI, AMP 0 THe &. CDC Only 0 Other
G. conect;"" Site Add""""
CoIIed",PhOl1e 1'«.'),, _ _ _ _ _ _ _ _ _ _ __
In
"""".,-d.,n"" willl ~2010
i!§gnatme
18:53 Jul 12, 2013
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~1liI~'i
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It
42096
Federal Register / Vol. 78, No. 135 / Monday, July 15, 2013 / Notices
FEDERAL DRUG TESTING CUSTODY AND CONTROL FORM
SPECIMEN ID 1\10,
0000001
STEP 1: COMPLETED BV COLLEClOR OR EMPLOYER REPRESENTATIVE
C,O""", SSNm
Eml>~"
ACCESSION NO,
UJ,N"' _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
o
USCG
0 HHS 0 NRC
DOT - Sp"cify OOT Aoenqr: 0 FMCSA 0 FAA 0 FAA 0 ITA 0 PHMSA
E, Re"""" br Telll: 0 ~'"fll1"nt 0 R""dorn 0 R""""",oble SUIlpi::;",,''C'"'''' 0 Po!iIl\.ecidenl 0 RelUlft io!My 0 FolwLll' 0
(opocify) _ _ _ _ _ __
" Drug T""181o be Perl","",d:
0 THe, COO, PCp, OPI, AMI' 0 THe 3: COC Only 0 OIhe, {"pooifyl _ _ _ _ _ _ _ _ _ _ _ _ __
Q, ColIeclioo Sit" Add",,,,,:
11 Sp""ify T"stin[l AMlhOl'iIy:
Oth.,
CoUe"'",pt,,,,,,, No, _ _ _ _ _ _ _ _ _ _ __
In "OO~ will!~ 1""""",1 ~""""''''' my ""rifklalion is:
o NEGATIVE
POSITIVE br:
0
o REFUSALlOTEST because - "heck fm..,nls} below:
o ADULTERATED (aduflel'1IDl/realloo):
o SOOSTITUTED
o OTHER:
o TEST CANCELLED
HEMARKS:
Sii_.<>If_OOI_O_
X
STEP l' COMPLETED BY MEDICAL REVIEW OFFICER . SPLIT SPECIMEN
l'mIffl _ _ ow 001<:01"._
Rr.~ II~
\.stoll
---1---1
llmTllollla!llY'
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"'_.
18:53 Jul 12, 2013
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I
I
wml"''''''''IIIn]
EN15JY13.003
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X
42097
Federal Register / Vol. 78, No. 135 / Monday, July 15, 2013 / Notices
FEDERAL DRUG TESTING CUSTODY AND CONTROL FORM
0000001
SPECIMEN ID NO.
STEP 1: COMPLETED BY COLLECTOR OR EMPLOYER REPRESENTATIVE
ACCESSION NO,
C.lJooor SSN or E"nployeeUl 1'10. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
11 Specify TeWng Authority:
0
HHS
0
NRC
0
DOT - Speoify DOT Agency:
0
!'MCSA
0
FAA.
0
D!=TiI. 0
FAA
PHMSA
0
USCG
E. ReMon fer T"IlI: 0 Pre-etTpl"l'menI 0 IlMoorn 0 RaruI,onoble SuspiilioNC!iII$e 0 Post Accident 0 Return tQ tlul:v 0 Folbw-up 0 DIner (specify) _ _ _ _ __
F. Drug reD!o b" P"lfofrfle.:i:
0 THe, COC, PCp, OPI, AMP
0 THe & coe Only
0 Other (spooifyJ _ _ _ _ _ _ _ _ _ _ _ _ __
G. CoNeolien Site Address:
C"lleGiorPhooe 1\10, _ _ _ _ _ _ _ _ _ _ __
l:n"oo~with"Pl'iiCliibfeF~I"'~ my ~Ii<",i",
o NEGATIVE
POSmVEror:
0
o REFUSAL TO TEST b"""""" - "heck ........,nls} bei"",,:
o ADULTERATED (rulullel>lJ1li,eM""):
o SUBSTITUTED
Ix
Ilil_
0IIi_
.
o TEST CANCELLED
PIllm -""'-"'01&0<'$14..".
_tli!~L••tl
!
I
1MIo1lil_.lVrl
STEP 7: COMPLETED BY MEDICAL REVIEW OFFICER SPLIT SPECIMEN
In 1Il""~ with ~Ie F~I re<;llJifem",,'" my ~fim, far the "PIN
$"""""""" (if teoled) is:
tkelley on DSK3SPTVN1PROD with NOTICES
X
VerDate Mar<15>2010
o TEST CANCELlED
iIil~"ID8iiIiiiiI_~
18:53 Jul 12, 2013
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------6.1l1~i
EN15JY13.004
o RECONFIRMED for:
o FAILED TO RECONFIRM lor;
42098
Federal Register / Vol. 78, No. 135 / Monday, July 15, 2013 / Notices
BILLING CODE 4162–20–C
Paper CCF: Back of Copy 5
Electronic CCF: Separate Page
Instructions for Completing the Federal
Drug Testing Custody and Control Form
for Urine Specimen Collection
When Making Entries on a Paper CCF,
use Black or Blue ink pen and Press
Firmly
Collector ensures that the name and
address of the HHS-certified
Instrumented Initial Test Facility (IITF)
or HHS-certified laboratory are on the
top of the Federal CCF and the
Specimen Identification (I.D.) number
on the top of the Federal CCF matches
the Specimen I.D. number on the labels/
seals.
tkelley on DSK3SPTVN1PROD with NOTICES
STEP 1:
• Collector ensures that the required
information is in STEP 1. Collector
enters a remark in STEP 2 if Donor
refuses to provide his/her SSN or
Employee I.D. number.
• Collector gives collection container
to Donor and instructs Donor to provide
a specimen. Collector notes any unusual
behavior or appearance of Donor in the
remarks line in STEP 2. If the Donor’s
conduct at any time during the
collection process clearly indicates an
attempt to tamper with the specimen,
Collector notes the conduct in the
remarks line in STEP 2 and takes action
as required.
STEP 2:
• Collector checks specimen
temperature within 4 minutes after
receiving the specimen from Donor, and
marks the appropriate temperature box
in STEP 2. If the temperature is outside
the acceptable range, Collector enters a
remark in STEP 2 and takes action as
required.
• Collector inspects the specimen and
notes any unusual findings in the
remarks line in STEP 2 and takes action
as required. Any specimen with unusual
physical characteristics (e.g., unusual
color, presence of foreign objects or
material, unusual odor) cannot be sent
to an IITF and must be sent to an HHScertified laboratory for testing, as
required.
• Collector determines the volume of
specimen in the collection container. If
the volume is acceptable, Collector
proceeds with the collection. If the
volume is less than required by the
federal agency, Collector takes action as
required, and enters remarks in STEP 2.
If no specimen is collected by the end
of the collection process, Collector
checks the None Provided box, enters a
remark in STEP 2, discards Copy 1, and
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distributes remaining copies as
required.
• Collector checks the Split or Single
specimen collection box. If the
collection is observed, Collector checks
the Observed box and enters a remark in
STEP 2.
STEP 3:
• Donor watches Collector pour the
specimen from the collection container
into the specimen bottle(s), place the
cap(s) on the specimen bottle(s), and
affix the label(s)/seal(s) on the specimen
bottle(s).
• Collector dates the specimen bottle
label(s) after placement on the specimen
bottle(s).
• Donor initials the specimen bottle
label(s) after placement on the specimen
bottle(s).
• Collector instructs the Donor to
read and complete the certification
statement in STEP 5 on Copy 2
(signature, printed name, date, phone
numbers, and date of birth). If Donor
refuses to sign the certification
statement, Collector enters a remark in
STEP 2 on Copy 1.
STEP 4:
• Collector completes STEP 4 on
Copy 1 (signature, printed name, date,
time of collection, and name of delivery
service) and places the sealed specimen
bottle(s) in a leak-proof plastic bag.
• Paper CCF: Collector places Copy 1
in the leak-proof plastic bag. Electronic
CCF: Collector places printed copy of
Copy 1 in the leak-proof plastic bag and/
or places package label (with Specimen
I.D., test facility name and contact
information, and collection site name
and contact information) on the outside
of the bag.
• Collector seals the bag, prepares the
specimen package for shipment, and
distributes the remaining CCF copies as
required.
Privacy Act Statement: (For Federal
Employees Only)
Submission of the information on the
Federal Drug Testing Custody and
Control Form is voluntary. However,
incomplete submission of the
information, refusal to provide a
specimen, or substitution or
adulteration of a specimen may result in
delay or denial of your application for
employment/appointment or may result
in removal from the federal service or
other disciplinary action.
The authority for obtaining the
specimen and identifying information
contained herein is Executive Order
12564 (‘‘Drug-Free Federal Workplace’’),
5 U.S.C. 3301 (2), 5 U.S.C. 7301, and
Section 503 of Public Law 100–71, 5
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U.S.C. 7301 note. Under provisions of
Executive Order 12564 and 5 U.S.C.
7301, test results may only be disclosed
to agency officials on a need-to-know
basis. This may include the agency
Medical Review Officer (MRO), the
administrator of the Employee
Assistance Program, and a supervisor
with authority to take adverse personnel
action. This information may also be
disclosed to a court where necessary to
defend against a challenge to an adverse
personnel action.
Submission of your SSN is not
required by law and is voluntary. Your
refusal to furnish your number will not
result in the denial of any right, benefit,
or privilege provided by law. Your SSN
is solicited, pursuant to Executive Order
9397, for purposes of associating
information in agency files relating to
you and for purposes of identifying the
specimen provided for testing for the
presence of illegal drugs. If you refuse
to indicate your SSN, a substitute
number or other identifier will be
assigned, as required, to process the
specimen.
Public Burden Statement
Public Burden Statement: An agency
may not conduct or sponsor, and a
person is not required to respond to, a
collection of information unless it
displays a currently valid OMB control
number. The OMB control number for
this project is 0930–0158. Public
reporting burden for this collection of
information is estimated to average: 5
minutes/donor; 4 minutes/collector; 3
minutes/test facility; and 3 minutes/
Medical Review Officer. Send
comments regarding this burden
estimate or any other aspect of this
collection of information, including
suggestions for reducing this burden, to
SAMHSA Reports Clearance Officer, 1
Choke Cherry Road, Room 2–1057,
Rockville, Maryland, 20857.
The number of respondents has been
reduced from 7.1 to a total of 6.1
million; which reduces the total burden
hours of ¥240,480.
Prior to an inspection, each test
facility is required to submit specific
information regarding its procedures.
Collecting this information prior to an
inspection allows the inspectors to
thoroughly review and understand the
testing procedures before arriving at the
test facility.
The NLCP application form has not
been revised compared to the previous
form.
The annual total burden estimates for
the Federal Drug Testing Custody and
Control Form, the NLCP application, the
NLCP inspection checklist, and NLCP
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Federal Register / Vol. 78, No. 135 / Monday, July 15, 2013 / Notices
recordkeeping requirements are shown
in the following table.
Burden/responses
(hours)
Number of form/respondents
Responses/
respondent
Total burden
hours
Custody and Control Form
Donor ....................................................................................................................................
Collector ................................................................................................................................
Laboratory .............................................................................................................................
Medical Review Officer .........................................................................................................
Laboratory Application .................................................................................................................
Laboratory Inspection Checklist ..................................................................................................
Laboratory Recordkeeping ..........................................................................................................
.08
.07
.05
.05
3.0
2.0
250.0
6,150,000
6,150,000
6,150,000
6,150,000
3
35
35
512,500
410,000
307,500
307,500
9
70
8750
Total ...............................................................................................................................
........................
........................
1,546,329
Written comments and
recommendations concerning the
proposed information collection should
be sent by August 14, 2013 to the
SAMHSA Desk Officer at the Office of
Information and Regulatory Affairs,
Office of Management and Budget
(OMB). To ensure timely receipt of
comments, and to avoid potential delays
in OMB’s receipt and processing of mail
sent through the U.S. Postal Service,
commenters are encouraged to submit
their comments to OMB via email to:
OIRA_Submission@omb.eop.gov.
Although commenters are encouraged to
send their comments via email,
commenters may also fax their
comments to: 202–395–7285.
Commenters may also mail them to:
Office of Management and Budget,
Office of Information and Regulatory
Affairs, New Executive Office Building,
Room 10102, Washington, DC 20503.
Summer King,
Statistician.
[FR Doc. 2013–16794 Filed 7–12–13; 8:45 am]
BILLING CODE 4162–20–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Substance Abuse and Mental Health
Services Administration
Announcement of Requirements and
Registration for the ‘‘Stay Covered
Challenge’’ and the ‘‘Churn Marketing
Research Methodology Development
Challenge’’
Authority: 15 U.S.C. 3719.
Substance Abuse and Mental
Health Services Administration, HHS.
ACTION: Notice.
tkelley on DSK3SPTVN1PROD with NOTICES
AGENCY:
The Substance Abuse and
Mental Health Services Administration
(SAMHSA), an operating division of the
U.S. Department of Health and Human
Services, is announcing a new
SUMMARY:
VerDate Mar<15>2010
18:53 Jul 12, 2013
Jkt 229001
opportunity for individuals and
organizations to help solve a critical
problem in today’s health environment.
Specifically, there are high levels of
involuntary breaks in health insurance
coverage among the non-elderly
population in the United States. These
breaks are referred to as ‘‘churning’’—
when people transition from one source
of insurance coverage to another when
eligibility for assistance changes.
Churning makes programs more
complicated and costly to administer
and can interrupt continuity of care,
create gaps in coverage, reduce health
plans’ incentive to invest in their
members’ long-term wellness, and
interfere with the accurate and
comprehensive measurement of health
care quality.
According to a study by the Urban
Institute, a total of 29.4 million people
will have their eligibility status change
each year beginning in 2014 1. This
challenge aligns with SAMHSA’s
mission to reduce the impact of mental
and substance use disorders on
America’s communities. SAMHSA
recognizes that enrollment in health
insurance plays a significant role in
fulfilling this mission, from preventive
health care to behavioral health
treatment and recovery. The National
Survey on Drug Use and Health
estimates that of the individuals
currently uninsured and expected to be
covered under the Affordable Care Act,
11 million will have a behavioral health
need. The literature on the causes of
breaks in coverage (i.e., income, housing
volatility), and the high prevalence of
behavioral health conditions among the
uninsured, points to an
interrelationship between behavioral
health symptoms and difficulties
complying with administrative
requirements in applying for and
maintaining continuous coverage.
Additionally, churning has a
significant amount of administrative as
well as health costs, and there is a
PO 00000
Frm 00063
Fmt 4703
Sfmt 4703
disproportionate impact of this problem
among individuals with behavioral
health disorders. Therefore, SAMHSA is
announcing two challenge projects to
help develop innovative solutions to the
barriers to developing a
communications strategy targeting
individuals who experience churn.
The statutory authority for this
challenge competition is section 105 of
the America Creating Opportunities to
Meaningfully Promote Excellence in
Technology, Education, and Science
Reauthorization Act of 2010
(COMPETES Act).
DATES: Challenge submissions accepted
until August 31, 2013.
FOR FURTHER INFORMATION CONTACT:
Kevin J. Malone, 1 Choke Cherry Road,
Room 8–1014, Rockville, MD 20857,
Office: 240.276.2239, Email:
kevin.malone@samhsa.hhs.gov.
SUPPLEMENTARY INFORMATION:
Subject of Challenge Competitions
SAMHSA is interested in identifying
individuals from a marketing
perspective who experience churn, and
in developing innovative strategies for
targeting them. SAMHSA has access to
relatively good data on the individuals
who are covered by Medicaid, based on
disability, and the providers and
community-based organizations that
serve them. However, SAMHSA has
very little capacity to identify the
individuals among the uninsured who
were disenrolled but remain eligible.
SAMHSA’s strategy is to use the
following two challenges to strengthen
communication with individuals in
both phases of the process (prior to
losing coverage, and once an individual
has been disenrolled), thereby reducing
incidences of churn and minimizing the
period between coverage if it does
happen.
1. The ‘‘Stay Covered Challenge’’ calls
for the development of a marketing/
outreach campaign designed for use by
E:\FR\FM\15JYN1.SGM
15JYN1
Agencies
[Federal Register Volume 78, Number 135 (Monday, July 15, 2013)]
[Notices]
[Pages 42091-42099]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-16794]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Agency Information Collection Activities: Submission for Office
of Management and Budget (OMB) Review; Comment Request
Periodically, the Substance Abuse and Mental Health Services
Administration (SAMHSA) will publish a summary of information
collection requests under OMB review, in compliance with the Government
Paperwork Elimination Act (GPEA) 44 U.S.C. 3504. To request a copy of
these documents, call the SAMHSA Reports Clearance Officer at (240)
276-1243.
[[Page 42092]]
Project: Mandatory Guidelines for Federal Workplace Drug Testing
Programs (OMB No. 0930-0158)--Revision
SAMHSA will request OMB approval for the Federal Drug Testing
Custody and Control Form (Federal CCF) for federal agency and federally
regulated drug testing programs which must comply with the HHS
Mandatory Guidelines for Federal Workplace Drug Testing Programs (73 FR
71858) dated November 25, 2008, and OMB approval for the information
provided by test facilities (i.e., laboratories and Instrumented
Initial Test Facilities, IITFs) for the National Laboratory
Certification Program (NLCP).
The Federal CCF is used by all federal agencies and employers
regulated by the Department of Transportation (DOT) to document the
collection and chain of custody of drug testing specimens at the
collection site, for the test facility to report results, and for the
Medical Review Officer (MRO) to make a determination. The current OMB-
approved Federal CCF has an August 31, 2013 expiration date. In
accordance with the GPEA, OMB set terms of clearance for the extension
of the current Federal CCF as follows: Prior to the next approval of
this package, the Agency (SAMHSA) shall provide a progress update on
adoption of electronic forms in an effort to reduce burden. SAMHSA is
encouraged to explore ways to convert the Federal Drug Testing Custody
and Control Form (Federal CCF) into an electronic form.
In an effort to comply with the stated terms of the clearance
requirement set forth by OMB, SAMHSA will authorize the use of an
electronic Federal CCF. SAMHSA has resubmitted the Federal CCF with no
content revisions to the form for OMB approval. The only revisions are
to enable the form to be used as a paper form or as an electronic form.
The first change to the Federal CCF is to allow the Public
Burden Statement to be a separate page of an electronic Federal CCF.
The Public Burden Statement must appear on all federal government forms
that place a reporting burden on gathering information.
The second change is to allow the Federal CCF instructions
and the Privacy Act Statement to be on a separate page or pages of an
electronic Federal CCF.
The third change is to allow the bottle labels/seals to be
printed separately, and not as a part of Copy 1 of the Federal CCF.
The fourth change is to revise the Federal CCF
Instructions to allow the use of an electronic form.
Below is a copy of the Federal CCF:
BILLING CODE 4162-20-P
[[Page 42093]]
[GRAPHIC] [TIFF OMITTED] TN15JY13.000
Paper CCF: Back of Copy 1-4
Electronic CCF: Separate Page
Public Burden Statement
Public Burden Statement: An agency may not conduct or sponsor, and
a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number. The OMB
control number for this project is 0930-0158. Public reporting burden
for this collection of information is estimated to average: 5 minutes/
donor; 4 minutes/collector; 3 minutes/test facility; and 3 minutes/
Medical Review Officer. Send comments regarding this burden estimate or
any other aspect of this
[[Page 42094]]
collection of information, including suggestions for reducing this
burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room
2-1057, Rockville, Maryland, 20857.
[GRAPHIC] [TIFF OMITTED] TN15JY13.001
[[Page 42095]]
[GRAPHIC] [TIFF OMITTED] TN15JY13.002
[[Page 42096]]
[GRAPHIC] [TIFF OMITTED] TN15JY13.003
[[Page 42097]]
[GRAPHIC] [TIFF OMITTED] TN15JY13.004
[[Page 42098]]
BILLING CODE 4162-20-C
Paper CCF: Back of Copy 5
Electronic CCF: Separate Page
Instructions for Completing the Federal Drug Testing Custody and
Control Form for Urine Specimen Collection
When Making Entries on a Paper CCF, use Black or Blue ink pen and Press
Firmly
Collector ensures that the name and address of the HHS-certified
Instrumented Initial Test Facility (IITF) or HHS-certified laboratory
are on the top of the Federal CCF and the Specimen Identification
(I.D.) number on the top of the Federal CCF matches the Specimen I.D.
number on the labels/seals.
STEP 1:
Collector ensures that the required information is in STEP
1. Collector enters a remark in STEP 2 if Donor refuses to provide his/
her SSN or Employee I.D. number.
Collector gives collection container to Donor and
instructs Donor to provide a specimen. Collector notes any unusual
behavior or appearance of Donor in the remarks line in STEP 2. If the
Donor's conduct at any time during the collection process clearly
indicates an attempt to tamper with the specimen, Collector notes the
conduct in the remarks line in STEP 2 and takes action as required.
STEP 2:
Collector checks specimen temperature within 4 minutes
after receiving the specimen from Donor, and marks the appropriate
temperature box in STEP 2. If the temperature is outside the acceptable
range, Collector enters a remark in STEP 2 and takes action as
required.
Collector inspects the specimen and notes any unusual
findings in the remarks line in STEP 2 and takes action as required.
Any specimen with unusual physical characteristics (e.g., unusual
color, presence of foreign objects or material, unusual odor) cannot be
sent to an IITF and must be sent to an HHS-certified laboratory for
testing, as required.
Collector determines the volume of specimen in the
collection container. If the volume is acceptable, Collector proceeds
with the collection. If the volume is less than required by the federal
agency, Collector takes action as required, and enters remarks in STEP
2. If no specimen is collected by the end of the collection process,
Collector checks the None Provided box, enters a remark in STEP 2,
discards Copy 1, and distributes remaining copies as required.
Collector checks the Split or Single specimen collection
box. If the collection is observed, Collector checks the Observed box
and enters a remark in STEP 2.
STEP 3:
Donor watches Collector pour the specimen from the
collection container into the specimen bottle(s), place the cap(s) on
the specimen bottle(s), and affix the label(s)/seal(s) on the specimen
bottle(s).
Collector dates the specimen bottle label(s) after
placement on the specimen bottle(s).
Donor initials the specimen bottle label(s) after
placement on the specimen bottle(s).
Collector instructs the Donor to read and complete the
certification statement in STEP 5 on Copy 2 (signature, printed name,
date, phone numbers, and date of birth). If Donor refuses to sign the
certification statement, Collector enters a remark in STEP 2 on Copy 1.
STEP 4:
Collector completes STEP 4 on Copy 1 (signature, printed
name, date, time of collection, and name of delivery service) and
places the sealed specimen bottle(s) in a leak-proof plastic bag.
Paper CCF: Collector places Copy 1 in the leak-proof
plastic bag. Electronic CCF: Collector places printed copy of Copy 1 in
the leak-proof plastic bag and/or places package label (with Specimen
I.D., test facility name and contact information, and collection site
name and contact information) on the outside of the bag.
Collector seals the bag, prepares the specimen package for
shipment, and distributes the remaining CCF copies as required.
Privacy Act Statement: (For Federal Employees Only)
Submission of the information on the Federal Drug Testing Custody
and Control Form is voluntary. However, incomplete submission of the
information, refusal to provide a specimen, or substitution or
adulteration of a specimen may result in delay or denial of your
application for employment/appointment or may result in removal from
the federal service or other disciplinary action.
The authority for obtaining the specimen and identifying
information contained herein is Executive Order 12564 (``Drug-Free
Federal Workplace''), 5 U.S.C. 3301 (2), 5 U.S.C. 7301, and Section 503
of Public Law 100-71, 5 U.S.C. 7301 note. Under provisions of Executive
Order 12564 and 5 U.S.C. 7301, test results may only be disclosed to
agency officials on a need-to-know basis. This may include the agency
Medical Review Officer (MRO), the administrator of the Employee
Assistance Program, and a supervisor with authority to take adverse
personnel action. This information may also be disclosed to a court
where necessary to defend against a challenge to an adverse personnel
action.
Submission of your SSN is not required by law and is voluntary.
Your refusal to furnish your number will not result in the denial of
any right, benefit, or privilege provided by law. Your SSN is
solicited, pursuant to Executive Order 9397, for purposes of
associating information in agency files relating to you and for
purposes of identifying the specimen provided for testing for the
presence of illegal drugs. If you refuse to indicate your SSN, a
substitute number or other identifier will be assigned, as required, to
process the specimen.
Public Burden Statement
Public Burden Statement: An agency may not conduct or sponsor, and
a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number. The OMB
control number for this project is 0930-0158. Public reporting burden
for this collection of information is estimated to average: 5 minutes/
donor; 4 minutes/collector; 3 minutes/test facility; and 3 minutes/
Medical Review Officer. Send comments regarding this burden estimate or
any other aspect of this collection of information, including
suggestions for reducing this burden, to SAMHSA Reports Clearance
Officer, 1 Choke Cherry Road, Room 2-1057, Rockville, Maryland, 20857.
The number of respondents has been reduced from 7.1 to a total of
6.1 million; which reduces the total burden hours of -240,480.
Prior to an inspection, each test facility is required to submit
specific information regarding its procedures. Collecting this
information prior to an inspection allows the inspectors to thoroughly
review and understand the testing procedures before arriving at the
test facility.
The NLCP application form has not been revised compared to the
previous form.
The annual total burden estimates for the Federal Drug Testing
Custody and Control Form, the NLCP application, the NLCP inspection
checklist, and NLCP
[[Page 42099]]
recordkeeping requirements are shown in the following table.
----------------------------------------------------------------------------------------------------------------
Burden/
Number of form/respondents responses Responses/ Total burden
(hours) respondent hours
----------------------------------------------------------------------------------------------------------------
Custody and Control Form
Donor....................................................... .08 6,150,000 512,500
Collector................................................... .07 6,150,000 410,000
Laboratory.................................................. .05 6,150,000 307,500
Medical Review Officer...................................... .05 6,150,000 307,500
Laboratory Application.......................................... 3.0 3 9
Laboratory Inspection Checklist................................. 2.0 35 70
Laboratory Recordkeeping........................................ 250.0 35 8750
-----------------------------------------------
Total................................................... .............. .............. 1,546,329
----------------------------------------------------------------------------------------------------------------
Written comments and recommendations concerning the proposed
information collection should be sent by August 14, 2013 to the SAMHSA
Desk Officer at the Office of Information and Regulatory Affairs,
Office of Management and Budget (OMB). To ensure timely receipt of
comments, and to avoid potential delays in OMB's receipt and processing
of mail sent through the U.S. Postal Service, commenters are encouraged
to submit their comments to OMB via email to: OIRA_Submission@omb.eop.gov. Although commenters are encouraged to send
their comments via email, commenters may also fax their comments to:
202-395-7285. Commenters may also mail them to: Office of Management
and Budget, Office of Information and Regulatory Affairs, New Executive
Office Building, Room 10102, Washington, DC 20503.
Summer King,
Statistician.
[FR Doc. 2013-16794 Filed 7-12-13; 8:45 am]
BILLING CODE 4162-20-P