Agency Forms Undergoing Paperwork Reduction Act Review, 75813-75815 [2014-29715]
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Federal Register / Vol. 79, No. 244 / Friday, December 19, 2014 / Notices
fnic.nal.usda.gov/dietary-guidance/
dietary-reference-intakes/dri-reports.
It has become apparent that a number
of unanticipated challenges were
encountered when chronic disease
endpoints were considered as indicators
for setting DRI reference values. Many of
these challenges were discussed in a
2007 ‘‘lessons learned’’ workshop
conducted by the IOM after the first six
DRI reports were published.3 Other
scientific publications have also
discussed the challenges, but
approaches for addressing the identified
challenges have not yet been adequately
explored.
Recently, the DRI Committees of the
U.S. and Canadian governments called
for nominations for nutrients to be
considered for future DRI reviews. Many
of the nominated nutrients cited new
data on chronic disease relationships as
the justification for new DRI reviews,
including three of the four nutrients
selected by the DRI Committees for
further consideration based on the
availability of sufficient new and
relevant evidence. Given the clear need
for more in-depth evaluation of the
challenges involved in incorporating
chronic disease endpoints into DRI
processes prior to initiating a new DRI
review, the two government committees
announced plans to sponsor a workshop
to be held in 2015 to address whether,
and how, chronic disease outcomes can
be incorporated into the process of
setting DRI values.
The limited time available for the
workshop may preclude consideration
of all issues relevant to the
incorporation of chronic disease
endpoints into DRI processes. As
warranted, subsequent activities will
address issues that arise in the
workshop or that have been identified
in other activities but not covered in
workshop discussions.
mstockstill on DSK4VPTVN1PROD with NOTICES
Written Public Comments
The key questions for the workshop,
on which the committees would like
public comments, are derived from prior
discussions of the major challenges in
incorporating chronic disease endpoints
into DRI considerations:
1. What dose-response models can be
considered for future DRI reviews when
chronic disease endpoints are used?
a. What are the scientific issues?
b. What are the options for addressing
these issues?
3 The Development of DRIs 1994–2004: Lessons
Learned and New Challenges, Workshop Summary,
November 30, 2007. Available from: https://
www.iom.edu/Reports/2007/The-Development-ofDRIs-1994-2004-Lessons-Learned-and-NewChallenges-Workshop-Summary.aspx.
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19:37 Dec 18, 2014
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c. What are the advantages and
disadvantages of the various options?
2. What are the evidentiary challenges
important in selecting and using chronic
disease endpoints in future DRI
reviews?
a. What are the scientific issues?
b. What are the options for addressing
these issues?
c. What are the advantages and
disadvantages of the various options?
3. What arguments can be made for
and against continuing to include
chronic disease endpoints in future DRI
reviews?
a. What are the scientific issues?
b. What are the options for addressing
these issues?
c. What are the advantages and
disadvantages of the various options?
Public comments are to be submitted via
email to DRI@hhs.gov. Provide a brief
summary (approx. 250 words) of the
points or issues. If providing literature
or other resources, one of the following
forms is preferred:
• Complete citation, as in a
bibliographic entry
• Abstract
• Electronic link to full article or report
Please provide comments as early as
possible in order to increase the
likelihood of having a meaningful
impact, as the workshop panelists will
be considering them prior to the
workshop. The deadline for comment
submission is Friday, January 30, 2015.
Comments received later than January
30, 2015 will not be considered.
Meeting Registration: The meeting
will be publicly accessible both inperson and by videocast on the Internet.
Due to limited seating capacity,
registration will be required for inperson attendance. Notice of registration
will be available on https://
www.health.gov/dri/prior to the
workshop; registration is expected to
open on or about February 15, 2015.
Dated: December 16, 2014.
Don Wright,
Deputy Assistant Secretary for Health,
Office of Disease Prevention and Health
Promotion,
Office of the Assistant Secretary for Health,
U.S. Department of Health and Human
Services.
[FR Doc. 2014–29766 Filed 12–18–14; 8:45 am]
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75813
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Disease Control and
Prevention
[30Day–15–14AQA]
Agency Forms Undergoing Paperwork
Reduction Act Review
The Centers for Disease Control and
Prevention (CDC) has submitted the
following information collection request
to the Office of Management and Budget
(OMB) for review and approval in
accordance with the Paperwork
Reduction Act of 1995. The notice for
the proposed information collection is
published to obtain comments from the
public and affected agencies.
Written comments and suggestions
from the public and affected agencies
concerning the proposed collection of
information are encouraged. Your
comments should address any of the
following: (a) Evaluate whether the
proposed collection of information is
necessary for the proper performance of
the functions of the agency, including
whether the information will have
practical utility; (b) Evaluate the
accuracy of the agencies estimate of the
burden of the proposed collection of
information, including the validity of
the methodology and assumptions used;
(c) Enhance the quality, utility, and
clarity of the information to be
collected; (d) Minimize the burden of
the collection of information on those
who are to respond, including through
the use of appropriate automated,
electronic, mechanical, or other
technological collection techniques or
other forms of information technology,
e.g., permitting electronic submission of
responses; and (e) Assess information
collection costs.
To request additional information on
the proposed project or to obtain a copy
of the information collection plan and
instruments, call (404) 639–7570 or
send an email to omb@cdc.gov. Written
comments and/or suggestions regarding
the items contained in this notice
should be directed to the Attention:
CDC Desk Officer, Office of Management
and Budget, Washington, DC 20503 or
by fax to (202) 395–5806. Written
comments should be received within 30
days of this notice.
Proposed Project
The Enhanced STD Surveillance
Network (eSSuN)—NEW—Division of
STD Prevention (DSTDP), National
Center for HIV/AIDS, Viral Hepatitis,
STD, and TB prevention (NCHHSTP),
Centers for Disease Control and
Prevention (CDC).
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mstockstill on DSK4VPTVN1PROD with NOTICES
75814
Federal Register / Vol. 79, No. 244 / Friday, December 19, 2014 / Notices
Background and Brief Description
The Enhanced STD surveillance
network Project is an active STD
sentinel surveillance network
comprised of 10 surveillance sites
including Baltimore City Health
Department, California Department of
Public Health, Florida Department of
Health, Massachusetts Department of
Public Health, Minnesota Department of
Health, Multnomah County Health
Department, New York City Department
of Health & Mental Hygiene,
Philadelphia Department of Public
Health, San Francisco Department of
Public Health, and Washington State
Department of Health.
The purpose of eSSuN is to be a
robust platform for the identification of
STD trends, monitor STD epidemiology
and evaluate the effectiveness of public
health interventions through active
surveillance collection, reporting,
analysis, visualization (e.g., mapping)
and interpretation of disease
information.
The objectives of the eSSuN project
are (1) provide a dataset of
supplemental information on gonorrhea
case reports of STDs of interest; (2)
provide geographic information on case
reports of STDs of interest for
investigating social determinants of
STDs; (3) monitor screening coverage for
chlamydial infection among young
women in sentinel clinical settings; (4)
monitor STD screening, incidence,
prevalence, epidemiologic and health
care access trends in populations of
interest such as men-who-have-sex-with
men (MSM), young people and persons
diagnosed with gonorrhea; (5) monitor
STD treatment and prevention service
practices; (6) monitor selected adverse
health outcomes of STDs; (7) evaluate
and enhance local and state STD
surveillance capacity; (8) enhance local
STD-specific health information
technology and epidemiologic capacity,
and, (9) establish a core of exemplary
state, tribal, territorial, county and/or
city health department STD surveillance
approaches to STD surveillance.
This project will utilize two distinct
surveillance strategies to collect
information. The first strategy employs
facility-based sentinel surveillance,
which will abstract standardized data
from existing electronic medical records
for all patient visits to participating STD
clinics and female patients aged 15–44
years of age visiting participating family
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19:37 Dec 18, 2014
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planning/reproductive health clinics
and other facilities (school-based clinics
and federally qualified healthcare
centers) during the project period. The
second strategy is population-based STD
surveillance among a random sample of
reported gonorrhea cases. Sampled
cases will be contacted for standardized
interview and the sample fraction will
be 250 completed enhanced
investigations or up to 2.5% of total
morbidity if annual cases exceed 10,000
cases. Enhanced investigations will also
include verification of treatment and an
internal health department record
review (performed on either all cases or
on the sampled cases).
For the facility-based component of
eSSuN, participating sites have
developed common protocols
stipulating data elements to be
collected, including patient
demographics, clinical, risk and sexual
behaviors. The specified data elements
are abstracted by clinic staff from
existing electronic medical records for;
(1) all patient visits to participating STD
clinics, (2) female patients aged 15—24
at participating family planning/
reproductive health clinics and, (3)
visits of female patients aged 15–44 at
school-based clinics and those attending
federally qualified health centers
(FQHCs) specifically for family planning
services.
Some of the participating facilities are
satellites clinics of large network
providers where clinical data systems
are centralized. Hence, there are a total
of 22 unique clinic data managers that
will be abstracting the facility data. Each
of the 22 clinic data managers will
spend 3 hours to extract and transmit
data to local/state health departments.
Individual patient records are deidentified (all patient-specific identifiers
are removed) by clinic staff before being
transmitted to health departments, who
recode the data into standardized
formats before being transmitted to CDC
through secure file transport
mechanisms. Data transmission will
occur on a monthly basis. Each eSSuN
site will spend 16 hours to recode and
transmit the data to CDC every month.
At CDC, data will be aggregated across
all participating sites in a common data
structures and formatted for analysis.
For the population-based surveillance
component, a random sample of
individuals residing within
participating jurisdictions and reported
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Fmt 4703
Sfmt 4703
with gonorrhea will be interviewed
using locally designed interview
templates following standardized data
protocols. Enhanced data collection
includes detailed information on
demographic characteristics, behavioral
risk factors and clinical history of
persons with gonorrhea. Each of the 10
sites will interview a minimum of 250
persons (or up to 2.5% of total
morbidity if annual GC cases exceed
10,000 cases) and each interview is
expected to take 10 minutes per person.
Interview data for the population-based
component will be collected through
telephone administered or in-person
interviews conducted by trained
interviewers in the 10 eSSuN sites.
These data will be directly entered into
existing STD surveillance information
systems at each health department. Data
will be locally extracted, de-identified
and recoded into standardized formats
prior to being transmitted to CDC
through secure file transport
mechanisms on a monthly basis.
Patient participation in the interview
is voluntary and refusal to participate
has no impact on other STD services the
local health provides to persons
diagnosed with gonorrhea. There is no
cost to the respondents beyond their
time and no compensation for
participation.
Both components of eSSuN are
designed to (1) integrate traditional
surveillance methods with innovative
data management technologies to
produce high-quality, timely
surveillance and epidemiologic data, (2)
provide valuable information to direct
public health STD prevention and
control efforts, (3) enhance
understanding of the community burden
of disease, (4) identify syndemic
patterns and population at greatest risk,
and, (5) monitor long-term health
consequences of STDs. The eSSuN
surveillance platform allows CDC to
establish and maintain common
standards for data collection,
transmission, and analysis, and to build
and maintain STD surveillance
expertise in 10 state or city health
departments. Such common systems,
established mechanisms of
communication, and in-place expertise
are all critical components for timely,
flexible, and high quality surveillance.
The total estimated annual burden is
2,854 hours of effort.
E:\FR\FM\19DEN1.SGM
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75815
Federal Register / Vol. 79, No. 244 / Friday, December 19, 2014 / Notices
ESTIMATED ANNUALIZED BURDEN HOURS
Number of
respondents
Type of respondent
Form name
Clinic Data manager at clinic ..........................
Data Manager electronic Transmission .........
Record Abstraction (No Form) .......................
Case Reports (No Form) ...............................
Patient Interview .............................................
Health Department Data Manager ..................
Gonorrhea Patients sampled and interviewed
Leroy A. Richardson,
Chief, Information Collection Review Office,
Office of Scientific Integrity, Office of the
Associate Director for Science, Office of the
Director, Centers for Disease Control and
Prevention.
[FR Doc. 2014–29715 Filed 12–18–14; 8:45 am]
BILLING CODE 4163–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifiers: CMS–10536 and
CMS–R–262]
Agency Information Collection
Activities: Submission for OMB
Review; Comment Request
ACTION:
Notice.
The Centers for Medicare &
Medicaid Services (CMS) is announcing
an opportunity for the public to
comment on CMS’ intention to collect
information from the public. Under the
Paperwork Reduction Act of 1995
(PRA), federal agencies are required to
publish notice in the Federal Register
concerning each proposed collection of
information, including each proposed
extension or reinstatement of an existing
collection of information, and to allow
a second opportunity for public
comment on the notice. Interested
persons are invited to send comments
regarding the 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.
DATES: Comments on the collection(s) of
information must be received by the
OMB desk officer by January 20, 2015.
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SUMMARY:
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19:37 Dec 18, 2014
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When commenting on the
proposed information collections,
please reference the document identifier
or OMB control number. To be assured
consideration, comments and
recommendations must be received by
the OMB desk officer via one of the
following transmissions: OMB, Office of
Information and Regulatory Affairs,
Attention: CMS Desk Officer, Fax
Number: (202) 395–5806 OR Email:
OIRA_submission@omb.eop.gov.
To obtain copies of a supporting
statement and any related forms for the
proposed collection(s) summarized in
this notice, you may make your request
using one of following:
1. Access CMS’ Web site address at
https://www.cms.hhs.gov/
PaperworkReductionActof1995.
2. Email your request, including your
address, phone number, OMB number,
and CMS document identifier, to
Paperwork@cms.hhs.gov.
3. Call the Reports Clearance Office at
(410) 786–1326.
FOR FURTHER INFORMATION CONTACT:
Reports Clearance Office at (410) 786–
1326.
ADDRESSES:
Under the
Paperwork Reduction Act of 1995 (PRA)
(44 U.S.C. 3501–3520), federal agencies
must obtain approval from the Office of
Management and Budget (OMB) for each
collection of information they conduct
or sponsor. The term ‘‘collection of
information’’ is defined in 44 U.S.C.
3502(3) and 5 CFR 1320.3(c) and
includes agency requests or
requirements that members of the public
submit reports, keep records, or provide
information to a third party. Section
3506(c)(2)(A) of the PRA (44 U.S.C.
3506(c)(2)(A)) requires federal agencies
to publish a 30-day notice in the
Federal Register concerning each
proposed collection of information,
including each proposed extension or
reinstatement of an existing collection
of information, before submitting the
collection to OMB for approval. To
comply with this requirement, CMS is
publishing this notice that summarizes
the following proposed collection(s) of
information for public comment:
SUPPLEMENTARY INFORMATION:
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Number of
responses per
respondent
Average
burden per
response
(hours)
22
6
3
10
3,225
12
1
16
10/60
1. Type of Information Collection
Request: New collection (Request for a
new OMB control number); Title of
Information Collection: Medicaid
Eligibility and Enrollment (EE)
Implementation Advanced Planning
Document (IAPD) Template; Use: To
assess the appropriateness of states’
requests for enhanced federal financial
participation for expenditures related to
Medicaid eligibility determination
systems, we will review the submitted
information and documentation to make
an approval determination for the
advanced planning document. The
package has been revised subsequent to
the publication of the 60-day Federal
Register notice (79 FR 51571). Form
Number: CMS–10536 (OMB control
number: 0938–New); Frequency: Yearly,
once, and occasionally; Affected Public:
State, Local, or Tribal Governments;
Number of Respondents: 56; Total
Annual Responses: 168; Total Annual
Hours: 1,344. (For policy questions
regarding this collection contact
Christine Gerhardt at 410–786–0693).
2. Type of Information Collection
Request: Revision of a currently
approved collection; Title of
Information Collection: CY 2016 Plan
Benefit Package (PBP) Software and
Formulary Submission; Use: We require
that Medicare Advantage and
Prescription Drug Plan organizations
submit a completed PBP and formulary
as part of the annual bidding process.
During this process, organizations
prepare their proposed plan benefit
packages for the upcoming contract year
and submit them to us for review and
approval. We publish beneficiary
education information using a variety of
formats. The specific education
initiatives that utilize PBP and
formulary data include web application
tools on www.medicare.gov and the plan
benefit insert in the Medicare & You
handbook. In addition, organizations
utilize the PBP data to generate their
Summary of Benefits marketing
information. Please note that the
package has been revised subsequent to
the publication of the 60-day Federal
Register notice (79 FR 57931). Form
Number: CMS–R–262 (OMB control
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]]>Agencies
[Federal Register Volume 79, Number 244 (Friday, December 19, 2014)]
[Notices]
[Pages 75813-75815]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-29715]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
[30Day-15-14AQA]
Agency Forms Undergoing Paperwork Reduction Act Review
The Centers for Disease Control and Prevention (CDC) has submitted
the following information collection request to the Office of
Management and Budget (OMB) for review and approval in accordance with
the Paperwork Reduction Act of 1995. The notice for the proposed
information collection is published to obtain comments from the public
and affected agencies.
Written comments and suggestions from the public and affected
agencies concerning the proposed collection of information are
encouraged. Your comments should address any of the following: (a)
Evaluate whether the proposed collection of information is necessary
for the proper performance of the functions of the agency, including
whether the information will have practical utility; (b) Evaluate the
accuracy of the agencies estimate of the burden of the proposed
collection of information, including the validity of the methodology
and assumptions used; (c) Enhance the quality, utility, and clarity of
the information to be collected; (d) Minimize the burden of the
collection of information on those who are to respond, including
through the use of appropriate automated, electronic, mechanical, or
other technological collection techniques or other forms of information
technology, e.g., permitting electronic submission of responses; and
(e) Assess information collection costs.
To request additional information on the proposed project or to
obtain a copy of the information collection plan and instruments, call
(404) 639-7570 or send an email to omb@cdc.gov. Written comments and/or
suggestions regarding the items contained in this notice should be
directed to the Attention: CDC Desk Officer, Office of Management and
Budget, Washington, DC 20503 or by fax to (202) 395-5806. Written
comments should be received within 30 days of this notice.
Proposed Project
The Enhanced STD Surveillance Network (eSSuN)--NEW--Division of STD
Prevention (DSTDP), National Center for HIV/AIDS, Viral Hepatitis, STD,
and TB prevention (NCHHSTP), Centers for Disease Control and Prevention
(CDC).
[[Page 75814]]
Background and Brief Description
The Enhanced STD surveillance network Project is an active STD
sentinel surveillance network comprised of 10 surveillance sites
including Baltimore City Health Department, California Department of
Public Health, Florida Department of Health, Massachusetts Department
of Public Health, Minnesota Department of Health, Multnomah County
Health Department, New York City Department of Health & Mental Hygiene,
Philadelphia Department of Public Health, San Francisco Department of
Public Health, and Washington State Department of Health.
The purpose of eSSuN is to be a robust platform for the
identification of STD trends, monitor STD epidemiology and evaluate the
effectiveness of public health interventions through active
surveillance collection, reporting, analysis, visualization (e.g.,
mapping) and interpretation of disease information.
The objectives of the eSSuN project are (1) provide a dataset of
supplemental information on gonorrhea case reports of STDs of interest;
(2) provide geographic information on case reports of STDs of interest
for investigating social determinants of STDs; (3) monitor screening
coverage for chlamydial infection among young women in sentinel
clinical settings; (4) monitor STD screening, incidence, prevalence,
epidemiologic and health care access trends in populations of interest
such as men-who-have-sex-with men (MSM), young people and persons
diagnosed with gonorrhea; (5) monitor STD treatment and prevention
service practices; (6) monitor selected adverse health outcomes of
STDs; (7) evaluate and enhance local and state STD surveillance
capacity; (8) enhance local STD-specific health information technology
and epidemiologic capacity, and, (9) establish a core of exemplary
state, tribal, territorial, county and/or city health department STD
surveillance approaches to STD surveillance.
This project will utilize two distinct surveillance strategies to
collect information. The first strategy employs facility-based sentinel
surveillance, which will abstract standardized data from existing
electronic medical records for all patient visits to participating STD
clinics and female patients aged 15-44 years of age visiting
participating family planning/reproductive health clinics and other
facilities (school-based clinics and federally qualified healthcare
centers) during the project period. The second strategy is population-
based STD surveillance among a random sample of reported gonorrhea
cases. Sampled cases will be contacted for standardized interview and
the sample fraction will be 250 completed enhanced investigations or up
to 2.5% of total morbidity if annual cases exceed 10,000 cases.
Enhanced investigations will also include verification of treatment and
an internal health department record review (performed on either all
cases or on the sampled cases).
For the facility-based component of eSSuN, participating sites have
developed common protocols stipulating data elements to be collected,
including patient demographics, clinical, risk and sexual behaviors.
The specified data elements are abstracted by clinic staff from
existing electronic medical records for; (1) all patient visits to
participating STD clinics, (2) female patients aged 15--24 at
participating family planning/reproductive health clinics and, (3)
visits of female patients aged 15-44 at school-based clinics and those
attending federally qualified health centers (FQHCs) specifically for
family planning services.
Some of the participating facilities are satellites clinics of
large network providers where clinical data systems are centralized.
Hence, there are a total of 22 unique clinic data managers that will be
abstracting the facility data. Each of the 22 clinic data managers will
spend 3 hours to extract and transmit data to local/state health
departments. Individual patient records are de-identified (all patient-
specific identifiers are removed) by clinic staff before being
transmitted to health departments, who recode the data into
standardized formats before being transmitted to CDC through secure
file transport mechanisms. Data transmission will occur on a monthly
basis. Each eSSuN site will spend 16 hours to recode and transmit the
data to CDC every month. At CDC, data will be aggregated across all
participating sites in a common data structures and formatted for
analysis.
For the population-based surveillance component, a random sample of
individuals residing within participating jurisdictions and reported
with gonorrhea will be interviewed using locally designed interview
templates following standardized data protocols. Enhanced data
collection includes detailed information on demographic
characteristics, behavioral risk factors and clinical history of
persons with gonorrhea. Each of the 10 sites will interview a minimum
of 250 persons (or up to 2.5% of total morbidity if annual GC cases
exceed 10,000 cases) and each interview is expected to take 10 minutes
per person. Interview data for the population-based component will be
collected through telephone administered or in-person interviews
conducted by trained interviewers in the 10 eSSuN sites. These data
will be directly entered into existing STD surveillance information
systems at each health department. Data will be locally extracted, de-
identified and recoded into standardized formats prior to being
transmitted to CDC through secure file transport mechanisms on a
monthly basis.
Patient participation in the interview is voluntary and refusal to
participate has no impact on other STD services the local health
provides to persons diagnosed with gonorrhea. There is no cost to the
respondents beyond their time and no compensation for participation.
Both components of eSSuN are designed to (1) integrate traditional
surveillance methods with innovative data management technologies to
produce high-quality, timely surveillance and epidemiologic data, (2)
provide valuable information to direct public health STD prevention and
control efforts, (3) enhance understanding of the community burden of
disease, (4) identify syndemic patterns and population at greatest
risk, and, (5) monitor long-term health consequences of STDs. The eSSuN
surveillance platform allows CDC to establish and maintain common
standards for data collection, transmission, and analysis, and to build
and maintain STD surveillance expertise in 10 state or city health
departments. Such common systems, established mechanisms of
communication, and in-place expertise are all critical components for
timely, flexible, and high quality surveillance.
The total estimated annual burden is 2,854 hours of effort.
[[Page 75815]]
Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
Average
Number of Number of burden per
Type of respondent Form name respondents responses per response
respondent (hours)
----------------------------------------------------------------------------------------------------------------
Clinic Data manager at clinic......... Data Manager electronic 22 6 3
Transmission.
Record Abstraction (No
Form).
Health Department Data Manager........ Case Reports (No Form).. 10 12 16
Gonorrhea Patients sampled and Patient Interview....... 3,225 1 10/60
interviewed.
----------------------------------------------------------------------------------------------------------------
Leroy A. Richardson,
Chief, Information Collection Review Office, Office of Scientific
Integrity, Office of the Associate Director for Science, Office of the
Director, Centers for Disease Control and Prevention.
[FR Doc. 2014-29715 Filed 12-18-14; 8:45 am]
BILLING CODE 4163-18-P
