Agency Forms Undergoing Paperwork Reduction Act Review, 48428-48430 [2018-20807]
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48428
Federal Register / Vol. 83, No. 186 / Tuesday, September 25, 2018 / Notices
threats, both domestically and
internationally to its components,
which are as follows:
Æ Center for Global Health (CBB)
Æ Center for Preparedness and Response
(CBC)
Æ Center for State, Tribal, Local and
Territorial Support (CBD)
Æ Office of Minority Health and Health
Equity (CBE)
• Deputy Director for Public Health
Science and Surveillance (CP): The
Deputy Director for Public Health
Science and Surveillance leads,
promotes, and facilitates science,
surveillance, standards and policies to
reduce the burden of diseases in the
United States and globally to its
components, which are as follows:
Æ National Center for Health Statistics
(CPC)
Æ Center for Surveillance,
Epidemiology, and Laboratory
Services (CPN)
Æ Office of Science (CPP)
Æ Office of Laboratory Science and
Safety (CPQ)
• Deputy Director for Non-Infectious
Diseases (CU): The Deputy Director for
Non-Infectious Diseases reduces the
burden of non-infectious diseases,
injuries, birth defects, disabilities and
environmental health hazards to its
components, which are as follows:
Æ National Center on Birth Defects and
Developmental Disabilities (CUB)
Æ National Center for Chronic Disease
Prevention and Health Promotion
(CUC)
Æ National Center for Environmental
Health/Agency for Toxic Substances
and Disease Registry (CUG)
Æ National Center for Injury Prevention
and Control (CUH)
• Deputy Director for Infectious
Diseases (CV): Deputy Director for
Infectious Diseases leads, promotes, and
facilitates science, programs, and
policies to reduce the burden of
infectious disease in the United States
and globally and its components, which
are as follows:
Æ National Center for Immunization and
Respiratory Diseases (CVG)
Æ National Center for Emerging and
Zoonotic Infectious Diseases (CVL)
Æ National Center for HIV/AIDS, Viral
Hepatitis, STD and TB Prevention
IV. Delegations of Authority: All
delegations and redelegations of
authority made to officials and
employees of affected organizational
components will continue in them or
their successors pending further
redelegation, provided they are
consistent with this reorganization.
Authority: 44 U.S.C. 3101.
VerDate Sep<11>2014
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Dated: August 17, 2018.
Alex M. Azar II,
Secretary.
[FR Doc. 2018–20835 Filed 9–24–18; 8:45 am]
BILLING CODE 4160–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Disease Control and
Prevention
[30Day–18–0891]
Agency Forms Undergoing Paperwork
Reduction Act Review
In accordance with the Paperwork
Reduction Act of 1995, the Centers for
Disease Control and Prevention (CDC)
has submitted the information
collection request titled World Trade
Center Health Program Enrollment,
Treatment, Appeals & Reimbursement to
the Office of Management and Budget
(OMB) for review and approval. CDC
previously published a ‘‘Proposed Data
Collection Submitted for Public
Comment and Recommendations’’
notice on May 11, 2018, to obtain
comments from the public and affected
agencies. CDC did not receive comments
related to the previous notice. This
notice serves to allow an additional 30
days for public and affected agency
comments.
CDC will accept all comments for this
proposed information collection project.
The Office of Management and Budget
is particularly interested in comments
that:
(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
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Frm 00020
Fmt 4703
Sfmt 4703
instruments, call (404) 639–7570 or
send an email to omb@cdc.gov. Direct
written comments and/or suggestions
regarding the items contained in this
notice to the Attention: CDC Desk
Officer, Office of Management and
Budget, 725 17th Street NW,
Washington, DC 20503 or by fax to (202)
395–5806. Provide written comments
within 30 days of notice publication.
Proposed Project
World Trade Center Health Program
Enrollment, Treatment, Appeals &
Reimbursement (OMB Control No.
0920–0891, Expires 09/30/2018)—
Revision—National Institute for
Occupational Safety and Health
(NIOSH), Centers for Disease Control
and Prevention (CDC).
Background and Brief Description
NIOSH seeks to request OMB
approval to revise the currently
approved information collection
activities that support the World Trade
Center (WTC) Health Program. The
James Zadroga 9/11 Health and
Compensation Act of 2010 (Pub. L. 111–
347, as amended by Pub. L. 114–113)
created the WTC Health Program to
provide medical monitoring and
treatment benefits to eligible individuals
affected by the terrorist attacks on
September 11, 2001. Eligible individuals
include firefighters and related
personnel, law enforcement officers,
and rescue, recovery, and cleanup
workers who responded to the attacks in
New York City, at the Pentagon, and in
Shanksville, Pennsylvania (responders),
and to eligible persons who were
present in the dust or dust cloud on
September 11, 2001, or who worked,
resided, or attended school, childcare,
or adult daycare in the New York City
disaster area (survivors).
This request also seeks to incorporate
information collection previously
approved under the World Trade Center
Health Program Petition for the
Addition of a New WTC-Related Health
Condition for Coverage under the World
Trade Center (WTC) Health Program
(OMB No. 0920–0929, expiration date 7/
31/2018), which has been discontinued.
The revision of OMB No. 0920–0891
will provide a comprehensive summary
of information collection needed to
administer the World Trade Center
Health Program.
Since its inception in 2011, the WTC
Health Program has been approved to
collect information from applicants and
Program members (enrolled WTC
responders and survivors) concerning
eligibility and enrollment, appointment
of a designated representative, medical
care, travel reimbursement, and appeal
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Federal Register / Vol. 83, No. 186 / Tuesday, September 25, 2018 / Notices
of adverse Program decisions. The WTC
Health Program is also currently
approved to collect information from
Program medical providers, including
health condition certification requests
and pharmaceutical claims. The WTC
Health Program has determined that
some existing forms need to be updated,
and new information collections related
to a recent rulemaking should be added.
Changes to WTC Health Program
regulations in 42 CFR part 88 will
require the extension of existing
information collections. Specifically, 42
CFR 88.13 establishes procedures for the
appeal of Program decisions to disenroll
Program members and deny enrollment
to applicants. Appeals of enrollment
denial decisions, which include the
submission of appeal request letters, are
currently approved; the Program
proposes to extend this information
collection to account for the burden of
requests for appeal of disenrollment
decisions. Of the over 70,000 Program
members, we expect that 0.014 percent
(10) will be subsequently disenrolled
from the Program. Of those, we expect
that 30 percent (3) will appeal the
disenrollment decisions. We estimate
that the disenrollment appeal requests
will take no more than 0.5 hours per
respondent. The annual burden estimate
is 2 hours (rounded).
Section 42 CFR 88.21 establishes
procedures for the appeal of WTC
Health Program decisions to decertify a
WTC-related health condition, deny
certification, and deny treatment
authorization. Appeals of health
condition certification denials and
treatment authorization denials, which
include the submission of appeal
request letters, are currently approved;
the Program proposes to extend this
information collection to account for the
burden of requests for appeal of
decertification decisions. The
information collection will also be
expanded to allow Program members to
provide additional information and/or
an oral statement. Of the estimated
51,472 Program members who have at
least one health condition certification,
we estimate that 0.02 percent (10) will
be decertified, and 50 percent (5) of
those will appeal a decertification. We
estimate that the appeal request letter
will take no more than 0.5 hours per
respondent. Providing additional
information and/or an oral statement
will take no more than one hour per
respondent. The annual burden estimate
for decertification appeals is 8 hours.
We further estimate that Program
members request certification for 20,000
health conditions each year. Of those
20,000, we estimate that one percent
(200) of certification requests are denied
by the WTC Health Program. We also
expect that 30 percent of denied
certifications, or 60 individuals, will be
appealed. We estimate that the appeals
letter takes no more than 30 minutes
and providing additional information
and/or an oral statement will take no
more than one hour. The burden
estimate for certification denial appeals
is 90 hours.
In addition, of the projected 51,472
Program members who receive medical
care, we estimate that 0.05 percent (26)
will appeal a determination by the WTC
Health Program that the treatment being
sought is not medically necessary. We
estimate that the appeals letter will take
no more than 30 minutes and providing
additional information and/or an oral
statement will take no more than one
hour. The burden estimate for treatment
authorization denial appeals is 39
hours.
Finally, 42 CFR 88.23 establishes
procedures for the appeal of a WTC
Health Program decision to deny
reimbursement to a Program medical
provider for treatment determined not to
be medically necessary. Accordingly,
the Program proposes the addition of
information collected in the appeal
request. We estimate that of the nearly
52,000 Program providers, we estimate
that 1.15 percent (600) annually will be
denied reimbursement for treatment
found to be not medically necessary or
in accordance with treatment protocols,
and will appeal the decision. We
estimate that the appeal letter will take
no more than 0.5 hours to compile. The
burden estimate for treatment
reimbursement denial appeals is 300
hours.
The revision request also includes the
addition of a new form to allow
applicants and Program members to
grant permission to share information
with a third person about an
individual’s application or case. We
estimate that 30 applicants and
members will submit a Health Insurance
Portability and Accountability Act
(HIPAA) Release Form annually. The
form will to take no longer than 0.25
hours to complete. The burden estimate
for the HIPAA Release form is 8 hours.
The total estimated annualized
burden hours are 14,063, an increase of
469 hours from the previously approved
estimate of 13,594 hours. The revised
estimate includes forms that have not
been modified; changes due to the
appeals processes authorized by 42 CFR
88.21 and 42 CFR 88.23; inclusion of the
new HIPPA Release Form; incorporation
of a form previously approved under
OMB No. 0920–0929; and miscellaneous
actions. The revision request provides a
detailed summary of each change and
its impact on the burden estimate.
BACKGROUND AND BRIEF DESCRIPTION
Form name
FDNY Responder ...............................
World Trade Center Health Program FDNY Responder Eligibility Application.
World Trade Center Health Program Responder Eligibility Application (Other than FDNY).
World Trade Center Health Program Pentagon/
Shanksville Responder.
World Trade Center Health Program Survivor Eligibility Application (all languages).
Clinic Selection Postcard for new general responders in NY/NJ to select a clinic.
Physician Request for Certification (WTC–3) .............
Denial Letter and Appeal Notification—Enrollment ....
General Responder ............................
Pentagon/Shanksville Responder ......
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WTC Survivor .....................................
General responder .............................
Program Medical Provider ..................
Responder (FDNY and General Responder)/Survivor.
Responder (FDNY and General Responder)/Survivor.
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Sfmt 4703
Average
burden per
response
(in hours)
45
1
30/60
2,475
1
30/60
630
1
30/60
1,350
1
30/60
2,475
1
15/60
20,000
45
1
1
30/60
30/60
3
1
30/60
Disenrollment Letter and Appeal Notification—Enrollment.
Jkt 244001
Number of
responses per
respondent
Number of
respondents
Type of respondent
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Federal Register / Vol. 83, No. 186 / Tuesday, September 25, 2018 / Notices
BACKGROUND AND BRIEF DESCRIPTION—Continued
Form name
Responder (FDNY and General Responder)/Survivor.
Responder (FDNY and General Responder)/Survivor.
Responder (FDNY and General Responder)/Survivor.
Responder (FDNY and General Responder)/Survivor.
Program Members ..............................
Program Member ...............................
Decertification Letter and Appeal Notification—
Health Condition.
Denial Letter and Appeal Notification—Health Condition Certification.
Denial Letter and Appeal Notification—Treatment
Authorization.
WTC Health Program Medical Travel Refund Request.
Designated Representative Form ...............................
HIPAA Release Form to allow the sharing of member information with a third party.
Outpatient prescription pharmaceuticals ....................
Reimbursement Denial Letter and Appeal Notification—Providers.
Petition for the addition of health conditions ..............
Pharmacy ...........................................
Program Medical Provider ..................
Responder/Survivor/Advocate (physician).
Jeffrey M. Zirger,
Acting 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. 2018–20807 Filed 9–24–18; 8:45 am]
BILLING CODE 4163–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
[Docket No. FDA–2018–N–3404]
Agency Information Collection
Activities; Proposed Collection;
Comment Request; Generic Drug User
Fee Cover Sheet
AGENCY:
Food and Drug Administration,
HHS.
ACTION:
Notice.
The Food and Drug
Administration (FDA or Agency) is
announcing an opportunity for public
comment on the proposed collection of
certain information by the Agency.
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 of an
existing collection of information, and
to allow 60 days for public comment in
response to the notice. This notice
solicits comments on collection of
information using Form FDA 3794,
entitled ‘‘Generic Drug User Fee Cover
Sheet.’’
DATES: Submit either electronic or
written comments on the collection of
information by November 26, 2018.
daltland on DSKBBV9HB2PROD with NOTICES
SUMMARY:
VerDate Sep<11>2014
17:40 Sep 24, 2018
Jkt 244001
You may submit comments
as follows. Please note that late,
untimely filed comments will not be
considered. Electronic comments must
be submitted on or before November 26,
2018. The https://www.regulations.gov
electronic filing system will accept
comments until 11:59 p.m. Eastern Time
at the end of November 26, 2018.
Comments received by mail/hand
delivery/courier (for written/paper
submissions) will be considered timely
if they are postmarked or the delivery
service acceptance receipt is on or
before that date.
ADDRESSES:
Electronic Submissions
Submit electronic comments in the
following way:
• Federal eRulemaking Portal:
https://www.regulations.gov. Follow the
instructions for submitting comments.
Comments submitted electronically,
including attachments, to https://
www.regulations.gov will be posted to
the docket unchanged. Because your
comment will be made public, you are
solely responsible for ensuring that your
comment does not include any
confidential information that you or a
third party may not wish to be posted,
such as medical information, your or
anyone else’s Social Security number, or
confidential business information, such
as a manufacturing process. Please note
that if you include your name, contact
information, or other information that
identifies you in the body of your
comments, that information will be
posted on https://www.regulations.gov.
• If you want to submit a comment
with confidential information that you
do not wish to be made available to the
public, submit the comment as a
written/paper submission and in the
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Fmt 4703
Number of
responses per
respondent
Number of
respondents
Type of respondent
Sfmt 4703
Average
burden per
response
(in hours)
5
1
1.5
60
1
1.5
26
1
1.5
10
1
10/60
30
30
1
1
15/60
15/60
150
600
261
1
1/60
30/60
60
1
1
manner detailed (see ‘‘Written/Paper
Submissions’’ and ‘‘Instructions’’).
Written/Paper Submissions
Submit written/paper submissions as
follows:
• Mail/Hand Delivery/Courier (for
written/paper submissions): Dockets
Management Staff (HFA–305), Food and
Drug Administration, 5630 Fishers
Lane, Rm. 1061, Rockville, MD 20852.
• For written/paper comments
submitted to the Dockets Management
Staff, FDA will post your comment, as
well as any attachments, except for
information submitted, marked and
identified, as confidential, if submitted
as detailed in ‘‘Instructions.’’
Instructions: All submissions received
must include the Docket No. FDA–
2018–N–3404 for ‘‘Agency Information
Collection Activities; Proposed
Collection; Comment Request; Generic
Drug User Fee Cover Sheet.’’ Received
comments, those filed in a timely
manner (see ADDRESSES), will be placed
in the docket and, except for those
submitted as ‘‘Confidential
Submissions,’’ publicly viewable at
https://www.regulations.gov or at the
Dockets Management Staff between 9
a.m. and 4 p.m., Monday through
Friday.
• Confidential Submissions—To
submit a comment with confidential
information that you do not wish to be
made publicly available, submit your
comments only as a written/paper
submission. You should submit two
copies total. One copy will include the
information you claim to be confidential
with a heading or cover note that states
‘‘THIS DOCUMENT CONTAINS
CONFIDENTIAL INFORMATION.’’ The
Agency will review this copy, including
the claimed confidential information, in
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Agencies
[Federal Register Volume 83, Number 186 (Tuesday, September 25, 2018)]
[Notices]
[Pages 48428-48430]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-20807]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
[30Day-18-0891]
Agency Forms Undergoing Paperwork Reduction Act Review
In accordance with the Paperwork Reduction Act of 1995, the Centers
for Disease Control and Prevention (CDC) has submitted the information
collection request titled World Trade Center Health Program Enrollment,
Treatment, Appeals & Reimbursement to the Office of Management and
Budget (OMB) for review and approval. CDC previously published a
``Proposed Data Collection Submitted for Public Comment and
Recommendations'' notice on May 11, 2018, to obtain comments from the
public and affected agencies. CDC did not receive comments related to
the previous notice. This notice serves to allow an additional 30 days
for public and affected agency comments.
CDC will accept all comments for this proposed information
collection project. The Office of Management and Budget is particularly
interested in comments that:
(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 [email protected]. Direct written comments
and/or suggestions regarding the items contained in this notice to the
Attention: CDC Desk Officer, Office of Management and Budget, 725 17th
Street NW, Washington, DC 20503 or by fax to (202) 395-5806. Provide
written comments within 30 days of notice publication.
Proposed Project
World Trade Center Health Program Enrollment, Treatment, Appeals &
Reimbursement (OMB Control No. 0920-0891, Expires 09/30/2018)--
Revision--National Institute for Occupational Safety and Health
(NIOSH), Centers for Disease Control and Prevention (CDC).
Background and Brief Description
NIOSH seeks to request OMB approval to revise the currently
approved information collection activities that support the World Trade
Center (WTC) Health Program. The James Zadroga 9/11 Health and
Compensation Act of 2010 (Pub. L. 111-347, as amended by Pub. L. 114-
113) created the WTC Health Program to provide medical monitoring and
treatment benefits to eligible individuals affected by the terrorist
attacks on September 11, 2001. Eligible individuals include
firefighters and related personnel, law enforcement officers, and
rescue, recovery, and cleanup workers who responded to the attacks in
New York City, at the Pentagon, and in Shanksville, Pennsylvania
(responders), and to eligible persons who were present in the dust or
dust cloud on September 11, 2001, or who worked, resided, or attended
school, childcare, or adult daycare in the New York City disaster area
(survivors).
This request also seeks to incorporate information collection
previously approved under the World Trade Center Health Program
Petition for the Addition of a New WTC-Related Health Condition for
Coverage under the World Trade Center (WTC) Health Program (OMB No.
0920-0929, expiration date 7/31/2018), which has been discontinued. The
revision of OMB No. 0920-0891 will provide a comprehensive summary of
information collection needed to administer the World Trade Center
Health Program.
Since its inception in 2011, the WTC Health Program has been
approved to collect information from applicants and Program members
(enrolled WTC responders and survivors) concerning eligibility and
enrollment, appointment of a designated representative, medical care,
travel reimbursement, and appeal
[[Page 48429]]
of adverse Program decisions. The WTC Health Program is also currently
approved to collect information from Program medical providers,
including health condition certification requests and pharmaceutical
claims. The WTC Health Program has determined that some existing forms
need to be updated, and new information collections related to a recent
rulemaking should be added.
Changes to WTC Health Program regulations in 42 CFR part 88 will
require the extension of existing information collections.
Specifically, 42 CFR 88.13 establishes procedures for the appeal of
Program decisions to disenroll Program members and deny enrollment to
applicants. Appeals of enrollment denial decisions, which include the
submission of appeal request letters, are currently approved; the
Program proposes to extend this information collection to account for
the burden of requests for appeal of disenrollment decisions. Of the
over 70,000 Program members, we expect that 0.014 percent (10) will be
subsequently disenrolled from the Program. Of those, we expect that 30
percent (3) will appeal the disenrollment decisions. We estimate that
the disenrollment appeal requests will take no more than 0.5 hours per
respondent. The annual burden estimate is 2 hours (rounded).
Section 42 CFR 88.21 establishes procedures for the appeal of WTC
Health Program decisions to decertify a WTC-related health condition,
deny certification, and deny treatment authorization. Appeals of health
condition certification denials and treatment authorization denials,
which include the submission of appeal request letters, are currently
approved; the Program proposes to extend this information collection to
account for the burden of requests for appeal of decertification
decisions. The information collection will also be expanded to allow
Program members to provide additional information and/or an oral
statement. Of the estimated 51,472 Program members who have at least
one health condition certification, we estimate that 0.02 percent (10)
will be decertified, and 50 percent (5) of those will appeal a
decertification. We estimate that the appeal request letter will take
no more than 0.5 hours per respondent. Providing additional information
and/or an oral statement will take no more than one hour per
respondent. The annual burden estimate for decertification appeals is 8
hours.
We further estimate that Program members request certification for
20,000 health conditions each year. Of those 20,000, we estimate that
one percent (200) of certification requests are denied by the WTC
Health Program. We also expect that 30 percent of denied
certifications, or 60 individuals, will be appealed. We estimate that
the appeals letter takes no more than 30 minutes and providing
additional information and/or an oral statement will take no more than
one hour. The burden estimate for certification denial appeals is 90
hours.
In addition, of the projected 51,472 Program members who receive
medical care, we estimate that 0.05 percent (26) will appeal a
determination by the WTC Health Program that the treatment being sought
is not medically necessary. We estimate that the appeals letter will
take no more than 30 minutes and providing additional information and/
or an oral statement will take no more than one hour. The burden
estimate for treatment authorization denial appeals is 39 hours.
Finally, 42 CFR 88.23 establishes procedures for the appeal of a
WTC Health Program decision to deny reimbursement to a Program medical
provider for treatment determined not to be medically necessary.
Accordingly, the Program proposes the addition of information collected
in the appeal request. We estimate that of the nearly 52,000 Program
providers, we estimate that 1.15 percent (600) annually will be denied
reimbursement for treatment found to be not medically necessary or in
accordance with treatment protocols, and will appeal the decision. We
estimate that the appeal letter will take no more than 0.5 hours to
compile. The burden estimate for treatment reimbursement denial appeals
is 300 hours.
The revision request also includes the addition of a new form to
allow applicants and Program members to grant permission to share
information with a third person about an individual's application or
case. We estimate that 30 applicants and members will submit a Health
Insurance Portability and Accountability Act (HIPAA) Release Form
annually. The form will to take no longer than 0.25 hours to complete.
The burden estimate for the HIPAA Release form is 8 hours.
The total estimated annualized burden hours are 14,063, an increase
of 469 hours from the previously approved estimate of 13,594 hours. The
revised estimate includes forms that have not been modified; changes
due to the appeals processes authorized by 42 CFR 88.21 and 42 CFR
88.23; inclusion of the new HIPPA Release Form; incorporation of a form
previously approved under OMB No. 0920-0929; and miscellaneous actions.
The revision request provides a detailed summary of each change and its
impact on the burden estimate.
Background and Brief Description
----------------------------------------------------------------------------------------------------------------
Number of Average burden
Type of respondent Form name Number of responses per per response
respondents respondent (in hours)
----------------------------------------------------------------------------------------------------------------
FDNY Responder..................... World Trade Center Health 45 1 30/60
Program FDNY Responder
Eligibility Application.
General Responder.................. World Trade Center Health 2,475 1 30/60
Program Responder
Eligibility Application
(Other than FDNY).
Pentagon/Shanksville Responder..... World Trade Center Health 630 1 30/60
Program Pentagon/
Shanksville Responder.
WTC Survivor....................... World Trade Center Health 1,350 1 30/60
Program Survivor
Eligibility Application
(all languages).
General responder.................. Clinic Selection Postcard 2,475 1 15/60
for new general responders
in NY/NJ to select a
clinic.
Program Medical Provider........... Physician Request for 20,000 1 30/60
Certification (WTC-3).
Responder (FDNY and General Denial Letter and Appeal 45 1 30/60
Responder)/Survivor. Notification--Enrollment.
Responder (FDNY and General Disenrollment Letter and 3 1 30/60
Responder)/Survivor. Appeal Notification--
Enrollment.
[[Page 48430]]
Responder (FDNY and General Decertification Letter and 5 1 1.5
Responder)/Survivor. Appeal Notification--
Health Condition.
Responder (FDNY and General Denial Letter and Appeal 60 1 1.5
Responder)/Survivor. Notification--Health
Condition Certification.
Responder (FDNY and General Denial Letter and Appeal 26 1 1.5
Responder)/Survivor. Notification--Treatment
Authorization.
Responder (FDNY and General WTC Health Program Medical 10 1 10/60
Responder)/Survivor. Travel Refund Request.
Program Members.................... Designated Representative 30 1 15/60
Form.
Program Member..................... HIPAA Release Form to allow 30 1 15/60
the sharing of member
information with a third
party.
Pharmacy........................... Outpatient prescription 150 261 1/60
pharmaceuticals.
Program Medical Provider........... Reimbursement Denial Letter 600 1 30/60
and Appeal Notification--
Providers.
Responder/Survivor/Advocate Petition for the addition 60 1 1
(physician). of health conditions.
----------------------------------------------------------------------------------------------------------------
Jeffrey M. Zirger,
Acting 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. 2018-20807 Filed 9-24-18; 8:45 am]
BILLING CODE 4163-18-P