Submission for OMB Review; Comment Request, 46284-46285 [2015-19001]
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46284
Federal Register / Vol. 80, No. 149 / Tuesday, August 4, 2015 / Notices
ESTIMATED ANNUALIZED BURDEN HOURS—Continued
Number of
responses per
respondent
Form name
Trainees participating in the Work@
Health® Program Wave 2.
Work@Health® Instructors/Coaches
Wave 2 Trainee Reaction Survey ....
200
1
15/60
50
Instructor/Coach Group Discussion
Guide.
..........................................................
7
1
30/60
4
........................
........................
........................
1,064
Total ...........................................
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. 2015–19042 Filed 8–3–15; 8:45 am]
BILLING CODE 4163–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier CMS–224–14]
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 September 3, 2015.
ADDRESSES: When commenting on the
proposed information collections,
tkelley on DSK3SPTVN1PROD with NOTICES
SUMMARY:
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18:45 Aug 03, 2015
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Number of
respondents
Avg. burden
per response
(in hrs.)
Type of
respondent
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/Paperwork
ReductionActof1995.
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.
SUPPLEMENTARY INFORMATION: 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:
1. Type of Information Collection
Request: New collection (Request for a
new OMB control number); Title of
PO 00000
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Total burden
(in hrs.)
Information Collection: Federally
Qualified Health Center Cost Report
Form; Use: Providers of services
participating in the Medicare program
are required under sections 1815(a) and
1861(v)(1)(A) of the Act (42 U.S.C.
1395g) to submit annual information to
achieve settlement of costs for health
care services rendered to Medicare
beneficiaries. In addition, regulations at
42 CFR 413.20 and 413.24 require
adequate cost data and cost reports from
providers on an annual basis. The form
CMS–224–14 cost report is needed to
determine a provider’s reasonable costs
incurred in furnishing medical services
to Medicare beneficiaries and
reimbursement due to or from a
provider. Form Number: CMS–224–14
(OMB control number 0938—New);
Frequency: Yearly; Affected Public:
Private sector—For-profit and Not-forprofit institutions; Number of
Respondents: 1,296; Total Annual
Responses: 1,296; Total Annual Hours:
75,168. (For policy questions regarding
this collection contact Julie Stankivic at
410–786–5725).
Dated: July 30, 2015.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office
of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2015–19075 Filed 8–3–15; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Submission for OMB Review;
Comment Request
Title: Initial Medical Exam Form and
Initial Dental Exam Form.
OMB No.: 0970–NEW.
Description: The Administration for
Children and Families’ Office of Refugee
Resettlement (ORR) places
unaccompanied minors in their custody
in licensed care provider facilities until
reunification with a qualified sponsor.
Care provider facilities are required to
provide children with services such as
E:\FR\FM\04AUN1.SGM
04AUN1
46285
Federal Register / Vol. 80, No. 149 / Tuesday, August 4, 2015 / Notices
classroom education, mental health
services, and health care. Pursuant to
Exhibit 1, part A.2 of the Flores
Settlement Agreement (Jenny Lisette
Flores, et al., v. Janet Reno, Attorney
General of the United States, et al., Case
No. CV 85–4544–RJK (C.D. Cal. 1996),
care provider facilities, on behalf of
ORR, shall arrange for appropriate
routine medical and dental care, family
planning services, and emergency
health care services, including a
complete medical examination
(including screening for infectious
disease) within 48 hours of admission,
excluding weekends and holidays,
unless the minor was recently examined
at another facility; appropriate
immunizations in accordance with the
U.S. Public Health Service (PHS), Center
for Disease Control; administration of
prescribed medication and special diets;
appropriate mental health interventions
when necessary for each minor in their
care.
The forms are to be used as
worksheets for clinicians, medical staff,
and the health department to compile
information that would otherwise have
been collected during the initial medical
or dental exam. Once completed, the
forms will be given to shelter staff for
data entry into ORR’s electronic data
repository known as the ‘UAC Portal’.
Data will be used to record UC health
on admission and for case management
of any identified illnesses/conditions.
Respondents: Clinicians, Health
Department staff, Office of Refugee
Resettlement Grantee staff.
ANNUAL BURDEN ESTIMATES
Number of
respondents
Instrument
Number of
responses per
respondent
Average
burden hours
per
response
Total burden
hours
Estimated Respondent Burden for Responding
Initial Medical Exam Form (including Appendix A: Supplemental TB Screening Form) ......................................................................................................
Initial Dental Exam Form .................................................................................
150
150
270
27
0.17
0.08
6,885
324
Estimated Total Burden Hours: 7,209.
ANNUAL BURDEN ESTIMATES
Number of
respondents
Instrument
Number of
responses per
respondent
Average
burden hours
per
response
Total burden
hours
Estimated Respondent Burden for Recordkeeping
tkelley on DSK3SPTVN1PROD with NOTICES
Initial Medical Exam Form (including Appendix A: Supplemental TB Screening Form) ......................................................................................................
Initial Dental Exam Form .................................................................................
Estimated Total Annual Burden 3,564.
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.
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, Email: OIRA_
SUBMISSION@OMB.EOP.GOV, Attn:
VerDate Sep<11>2014
18:45 Aug 03, 2015
Jkt 235001
150
150
Desk Officer for the Administration for
Children and Families.
Robert Sargis,
Reports Clearance Officer.
[FR Doc. 2015–19001 Filed 8–3–15; 8:45 am]
BILLING CODE 4184–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Submission for OMB Review;
Comment Request
Title: Trafficking Victim Assistance
Program Data.
OMB No.: 0970—NEW.
Description: The Trafficking Victims
Protection Act of 2000 (TVPA), as
amended, authorizes the Secretary of
Health and Human Services (HHS) to
expand benefits and services to foreign
nationals in the United States who are
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27
0.08
0.08
3,240
324
victims of severe forms of trafficking in
persons. Such benefits and services may
include services to assist potential
victims of trafficking. (Section
107(b)(1)(B) of the TVPA, 22 U.S.C.
7105(b)(1)(B)).
The Administration for Children and
Families (ACF) intends to award
cooperative agreements in fiscal year
2015 to approximately three
organizations that will ensure national
coverage. The awarded organization
must provide comprehensive case
management and referrals to qualified
persons, either directly through its own
organization or by partnering with other
organizations through contracts or both.
Persons qualified for services under
this grant are victims of a severe form
of trafficking in persons who have
received certification from HHS;
potential victims of a severe form of
trafficking who are actively seeking to
achieve HHS certification; family
members with derivative T visas, and
minor dependent children of foreign
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[Federal Register Volume 80, Number 149 (Tuesday, August 4, 2015)]
[Notices]
[Pages 46284-46285]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-19001]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Administration for Children and Families
Submission for OMB Review; Comment Request
Title: Initial Medical Exam Form and Initial Dental Exam Form.
OMB No.: 0970-NEW.
Description: The Administration for Children and Families' Office
of Refugee Resettlement (ORR) places unaccompanied minors in their
custody in licensed care provider facilities until reunification with a
qualified sponsor. Care provider facilities are required to provide
children with services such as
[[Page 46285]]
classroom education, mental health services, and health care. Pursuant
to Exhibit 1, part A.2 of the Flores Settlement Agreement (Jenny
Lisette Flores, et al., v. Janet Reno, Attorney General of the United
States, et al., Case No. CV 85-4544-RJK (C.D. Cal. 1996), care provider
facilities, on behalf of ORR, shall arrange for appropriate routine
medical and dental care, family planning services, and emergency health
care services, including a complete medical examination (including
screening for infectious disease) within 48 hours of admission,
excluding weekends and holidays, unless the minor was recently examined
at another facility; appropriate immunizations in accordance with the
U.S. Public Health Service (PHS), Center for Disease Control;
administration of prescribed medication and special diets; appropriate
mental health interventions when necessary for each minor in their
care.
The forms are to be used as worksheets for clinicians, medical
staff, and the health department to compile information that would
otherwise have been collected during the initial medical or dental
exam. Once completed, the forms will be given to shelter staff for data
entry into ORR's electronic data repository known as the `UAC Portal'.
Data will be used to record UC health on admission and for case
management of any identified illnesses/conditions.
Respondents: Clinicians, Health Department staff, Office of Refugee
Resettlement Grantee staff.
Annual Burden Estimates
----------------------------------------------------------------------------------------------------------------
Number of Average burden
Instrument Number of responses per hours per Total burden
respondents respondent response hours
----------------------------------------------------------------------------------------------------------------
Estimated Respondent Burden for Responding
----------------------------------------------------------------------------------------------------------------
Initial Medical Exam Form (including Appendix A: 150 270 0.17 6,885
Supplemental TB Screening Form)................
Initial Dental Exam Form........................ 150 27 0.08 324
----------------------------------------------------------------------------------------------------------------
Estimated Total Burden Hours: 7,209.
Annual Burden Estimates
----------------------------------------------------------------------------------------------------------------
Number of Average burden
Instrument Number of responses per hours per Total burden
respondents respondent response hours
----------------------------------------------------------------------------------------------------------------
Estimated Respondent Burden for Recordkeeping
----------------------------------------------------------------------------------------------------------------
Initial Medical Exam Form (including Appendix A: 150 270 0.08 3,240
Supplemental TB Screening Form)................
Initial Dental Exam Form........................ 150 27 0.08 324
----------------------------------------------------------------------------------------------------------------
Estimated Total Annual Burden 3,564.
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.
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, Email:
OIRA_SUBMISSION@OMB.EOP.GOV, Attn: Desk Officer for the Administration
for Children and Families.
Robert Sargis,
Reports Clearance Officer.
[FR Doc. 2015-19001 Filed 8-3-15; 8:45 am]
BILLING CODE 4184-01-P
