Agency Information Collection Activities: Proposed Collection; Comment Request, 27121-27123 [2019-12312]

Download as PDF Federal Register / Vol. 84, No. 112 / Tuesday, June 11, 2019 / Notices exceptions, the order will terminate in 20 years. The purpose of this analysis is to facilitate public comment on the order, and it is not intended to constitute an official interpretation of the complaint or order, or to modify the order’s terms in any way. By direction of the Commission. April J. Tabor, Acting Secretary. Office of Government-wide Policy (OGP), General Services Administration (GSA). ACTION: Notice. Office of Government-wide Policy (OGP), General Services Administration (GSA). ACTION: Notice of cancellation. AGENCY: Jkt 247001 This notice announces the cancellation of GSA Federal Management Regulation (FMR) Bulletin B–30. DATES: Applicable Date: June 11, 2019. FOR FURTHER INFORMATION CONTACT: Mr. James Vogelsinger, Office of Government-wide Policy, Office of Asset and Transportation Management at (202) 501–1764 or via email at vehicle.policy@gsa.gov. Please cite notice of FMR Bulletin B–30 cancellation. SUMMARY: This notice announces the cancellation of GSA Federal Management Regulation (FMR) Bulletin B–32. DATES: Applicable: June 11, 2019. FOR FURTHER INFORMATION CONTACT: For clarification of content or information, contact Mr. James Vogelsinger, Director, Office of Government-wide Policy, Office of Asset and Transportation Management at (202) 501–1764 or via email at vehicle.policy@gsa.gov. Please cite Notice for Cancellation of FMR Bulletin B–32 in the subject line. SUPPLEMENTARY INFORMATION: On May 24, 2011, the President issued a Presidential Memorandum on Federal Fleet Performance. This memorandum stated that any executive fleet vehicles that are larger than a midsize sedan or do not comply with alternative fueled vehicle (AFV) requirements must be disclosed on agency websites. On October 12, 2011, GSA provided guidance to agencies regarding the identification of executive fleet vehicles and the requirements to post them on agency websites by issuing FMR Bulletin B–32. On March 19, 2015, Executive Order 13693, Planning for Federal Sustainability in the Next Decade was signed which revoked the May 24, 2011 Presidential Memorandum on Federal Fleet Performance, effective as of October 1, 2015. Therefore, the requirement for any executive fleet vehicles that are larger than a midsize sedan or do not comply with AFV requirements to be disclosed on agency websites no longer exists. SUMMARY: SUPPLEMENTARY INFORMATION: A. Background GSA Bulletin FMR B–9 was issued on August 26, 2005. The Bulletin provided guidance to Executive Branch agencies on the development and maintenance of a documented Vehicle Allocation Methodology for agency fleets. GSA Bulletin FMR B–30 cancelled FMR Bulletin B–9, effective August 22, 2011. GSA Bulletin FMR B–43 subsequently superseded FMR Bulletin B–30, effective March 20, 2017. This cancellation of GSA FMR Bulletin B–30 clarifies that GSA FMR Bulletin B–43 is the only guidance on Vehicle Allocation Methodology in effect currently. B. Procedures Bulletins regarding motor vehicle management are located on the internet at http://www.gsa.gov/fmrbulletin as FMR bulletins. Jessica Salmoiraghi, Associate Administrator, Office of Government-wide Policy. [FR Doc. 2019–12239 Filed 6–10–19; 8:45 am] BILLING CODE 6820–14–P PO 00000 Frm 00047 Fmt 4703 Agency Information Collection Activities: Proposed Collection; Comment Request Sfmt 4703 This notice announces the intention of the Agency for Healthcare Research and Quality (AHRQ) to request that the Office of Management and Budget (OMB) approve the proposed information collection project: ‘‘Hospital Survey on Patient Safety Culture Comparative Database.’’ In accordance with the Paperwork Reduction Act, AHRQ invites the public to comment on this proposed information collection. This proposed information collection was previously published in the Federal Register on March 19, 2019, and allowed 60 days for public comment. AHRQ did not receive substantive comments. The purpose of this notice is to allow an additional 30 days for public comment. DATES: Comments on this notice must be received on or before 30 days after date of publication. ADDRESSES: Written comments should be submitted to: AHRQ’s OMB Desk Officer by fax at (202) 395–6974 (attention: AHRQ’s desk officer) or by email at OIRA_submission@ omb.eop.gov (attention: AHRQ’s desk officer). SUMMARY: AGENCY: Cancellation of FMR Bulletin B–32, Motor Vehicle Policy Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality, HHS. ACTION: Notice. Cancellation of FMR Bulletin B–30, Vehicle Allocation Methodology for Agency Fleets [Notice–MA–2019–05; Docket No. 2019– 0002, Sequence No. 11] DEPARTMENT OF HEALTH AND HUMAN SERVICES AGENCY: [Notice–MA–2019–04; Docket No. 2019– 0002, Sequence No. 8] GENERAL SERVICES ADMINISTRATION khammond on DSKBBV9HB2PROD with NOTICES [FR Doc. 2019–12240 Filed 6–10–19; 8:45 am] GENERAL SERVICES ADMINISTRATION BILLING CODE 6750–01–P 17:36 Jun 10, 2019 Jessica Salmoiraghi, Associate Administrator, Office of Government-wide Policy. BILLING CODE 6820–14–P [FR Doc. 2019–12279 Filed 6–10–19; 8:45 am] VerDate Sep<11>2014 Bulletins regarding motor vehicle management are located on the internet at http://www.gsa.gov/fmrbulletin as FMR bulletins. 27121 FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports Clearance Officer, (301) 427–1477, or by email at doris.lefkowitz@AHRQ.hhs.gov. SUPPLEMENTARY INFORMATION: Proposed Project Hospital Survey on Patient Safety Culture Comparative Database The Hospital Survey on Patient Safety Culture (Hospital SOPS) is designed to enable hospitals to assess provider and staff perspectives about patient safety issues, medical error, and error reporting. The Hospital SOPS includes 42 items that measure 12 composites of patient safety culture. AHRQ first made the Hospital SOPS publicly available, along with a Survey User’s Guide and other toolkit materials, in November 2004 on the AHRQ website. The Hospital Survey on Patient Safety Culture Comparative Database (Hospital SOPS Database) consists of data from E:\FR\FM\11JNN1.SGM 11JNN1 27122 Federal Register / Vol. 84, No. 112 / Tuesday, June 11, 2019 / Notices the Hospital SOPS and may include reportable, non-required supplemental items. Hospitals in the U.S. can voluntarily submit data from the survey to AHRQ, through its contractor, Westat. The Hospital SOPS Database (OMB NO. 0935–0162, last approved on September 30, 2016) was developed by AHRQ in 2006 in response to requests from hospitals interested in tracking their own survey results. Those organizations submitting data receive a feedback report, as well as a report of the aggregated de-identified findings of the other hospitals submitting data. These reports are used to assist hospital staff in their efforts to improve patient safety culture in their organizations. Rationale for the information collection. The Hospital SOPS and the Hospital SOPS Database support AHRQ’s goals of promoting improvements in the quality and safety of health care in hospital settings. The survey, toolkit materials, and database results are all made publicly available on AHRQ’s website. Technical assistance is provided by AHRQ through its contractor at no charge to hospitals, to facilitate the use of these materials for hospital patient safety and quality improvement. This database will: (1) Present results from hospitals that voluntarily submit their data, (2) provide data to hospitals to facilitate internal assessment and learning in the patient safety improvement process, and (3) provide supplemental information to help hospitals identify their strengths and areas with potential for improvement in patient safety culture. This study is being conducted by AHRQ through its contractor, Westat, pursuant to AHRQ’s statutory authority to conduct and support research on health care and on systems for the delivery of such care, including activities with respect to the quality, effectiveness, efficiency, appropriateness and value of healthcare services and with respect to surveys and database development. 42 U.S.C 299a(a)(1) and (8) Method of Collection To achieve the goal of this project the following activities and data collections will be implemented: (1) Eligibility and Registration Form— The hospital point-of-contact (POC) completes a number of data submission steps and forms, beginning with the completion of an online Eligibility and Registration Form. The purpose of this form is to collect basic demographic information about the hospital and initiate the registration process. (2) Data Use Agreement—The purpose of the data use agreement, completed by the hospital POC, is to state how data submitted by hospitals will be used and provide privacy assurances. (3) Hospital Site Information Form— The purpose of the site information form, also completed by the hospital POC, is to collect background characteristics of the hospital. This information will be used to analyze data collected with the Hospital SOPS survey. (4) Data Files Submission—POCs upload their data file(s), using hospital data file specifications, to ensure that users submit standardized and consistent data in the way variables are named, coded, and formatted. The number of submissions to the database is likely to vary each year because hospitals do not administer the survey and submit data every year. Data submission is typically handled by one POC who is either a patient safety manager in the hospital or a survey vendor who contracts with a hospital to collect and submit their data. POCs submit data on behalf of 3 hospitals, on average, because many hospitals are part of a health system that includes many hospitals, or the POC is a vendor that is submitting data for multiple hospitals. Estimated Annual Respondent Burden Exhibit 1 shows the estimated annualized burden hours for the respondents’ time to participate in the database. An estimated 340 POCs, each representing an average of 3 individual hospitals each, will complete the database submission steps and forms annually. Each POC will submit the following: • Eligibility and registration form (completion is estimated to take about 3 minutes). • Data Use Agreement (completion is estimated to take about 3 minutes). • Hospital Information Form (completion is estimated to take about 5 minutes). • Survey data submission will take an average of one hour. The total annual burden hours are estimated to be 459 hours. Exhibit 2 shows the estimated annualized cost burden based on the respondents’ time to submit their data. The cost burden is estimated to be $26,572 annually. EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS Number of respondents/ POCs Form name Number of responses per POC Hours per response Total burden hours Eligibility/Registration Form ............................................................................. Data Use Agreement ....................................................................................... Hospital Information Form ............................................................................... Data Files Submission ..................................................................................... 340 340 340 340 1 1 3 1 3/60 3/60 5/60 1 17 17 85 340 Total .......................................................................................................... N/A N/A N/A 459 khammond on DSKBBV9HB2PROD with NOTICES EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN Number of respondents/ POCs Form name Eligibility/Registration Form ............................................................................. Data Use Agreement ....................................................................................... Hospital Information Form ............................................................................... Data Files Submission ..................................................................................... VerDate Sep<11>2014 17:36 Jun 10, 2019 Jkt 247001 PO 00000 Frm 00048 Fmt 4703 Sfmt 4703 Total burden hours 340 340 340 340 E:\FR\FM\11JNN1.SGM 17 17 85 340 11JNN1 Average hourly wage rate * $57.89 57.89 57.89 57.89 Total cost burden $984 984 4,921 19,683 27123 Federal Register / Vol. 84, No. 112 / Tuesday, June 11, 2019 / Notices EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN—Continued Number of respondents/ POCs Form name Total .......................................................................................................... Total burden hours N/A N/A Average hourly wage rate * Total cost burden N/A 26,572 * Mean hourly wage of $57.89 for Medical and Health Services Managers (SOC code 11–9111) was obtained from the May 2017 National Industry-Specific Occupational Employment and Wage Estimates NAICS 622000—Hospitals, located at http://www.bls.gov/oes/current/naics3_ 622000.htm. Request for Comments In accordance with the Paperwork Reduction Act, comments on AHRQ’s information collection are requested with regard to any of the following: (a) Whether the proposed collection of information is necessary for the proper performance of AHRQ’s health care research and health care information dissemination functions, including whether the information will have practical utility; (b) the accuracy of AHRQ’s estimate of burden (including hours and costs) of the proposed collection(s) of information; (c) ways to enhance the quality, utility and clarity of the information to be collected; and (d) ways to minimize the burden of the collection of information upon the respondents, including the use of automated collection techniques or other forms of information technology. Comments submitted in response to this notice will be summarized and included in the Agency’s subsequent request for OMB approval of the proposed information collection. All comments will become a matter of public record. Virginia L. Mackay-Smith, Associate Director. [FR Doc. 2019–12312 Filed 6–10–19; 8:45 am] BILLING CODE 4160–90–P DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Agency Information Collection Activities: Proposed Collection; Comment Request Agency for Healthcare Research and Quality, HHS. ACTION: Notice. khammond on DSKBBV9HB2PROD with NOTICES AGENCY: This notice announces the intention of the Agency for Healthcare Research and Quality (AHRQ) to request that the Office of Management and Budget (OMB) approve the proposed information collection project: ‘‘The AHRQ Safety Program for Improving Antibiotic Use.’’ In accordance with the SUMMARY: VerDate Sep<11>2014 17:36 Jun 10, 2019 Jkt 247001 Paperwork Reduction Act, AHRQ invites the public to comment on this proposed information collection. This proposed information collection was previously published in the Federal Register on April 1, 2019 and allowed 60 days for public comment. AHRQ did not receive substantive comments. The purpose of this notice is to allow an additional 30 days for public comment. DATES: Comments on this notice must be received on or before 30 days after date of publication. ADDRESSES: Written comments should be submitted to: AHRQ’s OMB Desk Officer by fax at (202) 395–6974 (attention: AHRQ’s desk officer) or by email at OIRA_submission@ omb.eop.gov (attention: AHRQ’s desk officer). FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports Clearance Officer, (301) 427–1477, or by email at doris.lefkowitz@AHRQ.hhs.gov. SUPPLEMENTARY INFORMATION: Proposed Project The AHRQ Safety Program for Improving Antibiotic Use The Agency for Healthcare Research and Quality (AHRQ) requests to revise and extend the currently approved AHRQ Safety Program for Improving Antibiotic Use. The AHRQ Safety Program for Improving Antibiotic Use (the ‘‘AHRQ Safety Program’’) aims to help facilities implement antibiotic stewardship programs and to reduce unnecessary antibiotic prescribing. The AHRQ Safety Program has already been implemented in a pilot of integrated delivery systems and a national cohort of 400 acute care hospitals, and is currently being implemented in a national cohort of 500 long-term care facilities. The AHRQ Safety Program was last approved by OMB on September 25, 2017 and will expire on September 30, 2020. The request for extension is to allow for completion of activities and data collection in the AHRQ Safety Program, which are scheduled to occur through March 30, 2021. The OMB control number for the AHRQ Safety Program is 0935–0238. All of the supporting documents for the PO 00000 Frm 00049 Fmt 4703 Sfmt 4703 current AHRQ Safety Program can be downloaded from OMB’s website at https://www.reginfo.gov/public/do/ PRAViewICR?ref_nbr=201707-0935-003. The 2017 OMB clearance included one response for the Structural Assessment and the Medical Office Survey on Patient Safety Culture (MOSOPS), but did not include electronic health record (EHR) data or a second response for the Structural Assessment or MOSOPS for the 4th cohort planned for ambulatory settings. This was because the original OMB clearance expiration date fell in the middle of the planned 4th cohort, so the second Structural Assessment and MOSOPS were not within the approved information collection period, and EHR data collection would have been incomplete. In addition, the project team was not certain that the ambulatory care practices would be able to access EHR data. Based on the experience of the pilot cohort, however, it is believed that many ambulatory practices can access these data, and that these practices are more likely to feasibly participate in the AHRQ Safety Program. The revision also updates the estimated annual burden accordingly, and includes changes to the data collection forms which will be used for the ambulatory care cohort based on lessons learned during the pilot cohort. Background for This Collection As part of the Department of Health and Human Services (DHHS) Hospital Acquired Infection (HAI) National Action Plan (NAP), AHRQ has supported the implementation and adoption of the Comprehensive Unitbased Safety Program (CUSP) to reduce Central-Line Associated Bloodstream Infections (CLABSI) and CatheterAssociated Urinary Tract Infections (CAUTI), and subsequently applied CUSP to other clinical challenges, including reducing surgical site infections and improving care for mechanically ventilated patients. As part of the National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB NAP) to increase antibiotic stewardship (defined as organized efforts to promote the judicious use of E:\FR\FM\11JNN1.SGM 11JNN1

Agencies

[Federal Register Volume 84, Number 112 (Tuesday, June 11, 2019)]
[Notices]
[Pages 27121-27123]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-12312]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Agency for Healthcare Research and Quality, HHS.

ACTION: Notice.

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

SUMMARY: This notice announces the intention of the Agency for 
Healthcare Research and Quality (AHRQ) to request that the Office of 
Management and Budget (OMB) approve the proposed information collection 
project: ``Hospital Survey on Patient Safety Culture Comparative 
Database.'' In accordance with the Paperwork Reduction Act, AHRQ 
invites the public to comment on this proposed information collection.
    This proposed information collection was previously published in 
the Federal Register on March 19, 2019, and allowed 60 days for public 
comment. AHRQ did not receive substantive comments. The purpose of this 
notice is to allow an additional 30 days for public comment.

DATES: Comments on this notice must be received on or before 30 days 
after date of publication.

ADDRESSES: Written comments should be submitted to: AHRQ's OMB Desk 
Officer by fax at (202) 395-6974 (attention: AHRQ's desk officer) or by 
email at [email protected] (attention: AHRQ's desk officer).

FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports 
Clearance Officer, (301) 427-1477, or by email at 
[email protected].

SUPPLEMENTARY INFORMATION: 

Proposed Project

Hospital Survey on Patient Safety Culture Comparative Database

    The Hospital Survey on Patient Safety Culture (Hospital SOPS) is 
designed to enable hospitals to assess provider and staff perspectives 
about patient safety issues, medical error, and error reporting. The 
Hospital SOPS includes 42 items that measure 12 composites of patient 
safety culture. AHRQ first made the Hospital SOPS publicly available, 
along with a Survey User's Guide and other toolkit materials, in 
November 2004 on the AHRQ website.
    The Hospital Survey on Patient Safety Culture Comparative Database 
(Hospital SOPS Database) consists of data from

[[Page 27122]]

the Hospital SOPS and may include reportable, non-required supplemental 
items. Hospitals in the U.S. can voluntarily submit data from the 
survey to AHRQ, through its contractor, Westat. The Hospital SOPS 
Database (OMB NO. 0935-0162, last approved on September 30, 2016) was 
developed by AHRQ in 2006 in response to requests from hospitals 
interested in tracking their own survey results. Those organizations 
submitting data receive a feedback report, as well as a report of the 
aggregated de-identified findings of the other hospitals submitting 
data. These reports are used to assist hospital staff in their efforts 
to improve patient safety culture in their organizations.
    Rationale for the information collection. The Hospital SOPS and the 
Hospital SOPS Database support AHRQ's goals of promoting improvements 
in the quality and safety of health care in hospital settings. The 
survey, toolkit materials, and database results are all made publicly 
available on AHRQ's website. Technical assistance is provided by AHRQ 
through its contractor at no charge to hospitals, to facilitate the use 
of these materials for hospital patient safety and quality improvement.
    This database will:
    (1) Present results from hospitals that voluntarily submit their 
data,
    (2) provide data to hospitals to facilitate internal assessment and 
learning in the patient safety improvement process, and
    (3) provide supplemental information to help hospitals identify 
their strengths and areas with potential for improvement in patient 
safety culture.
    This study is being conducted by AHRQ through its contractor, 
Westat, pursuant to AHRQ's statutory authority to conduct and support 
research on health care and on systems for the delivery of such care, 
including activities with respect to the quality, effectiveness, 
efficiency, appropriateness and value of healthcare services and with 
respect to surveys and database development. 42 U.S.C 299a(a)(1) and 
(8)

Method of Collection

    To achieve the goal of this project the following activities and 
data collections will be implemented:
    (1) Eligibility and Registration Form--The hospital point-of-
contact (POC) completes a number of data submission steps and forms, 
beginning with the completion of an online Eligibility and Registration 
Form. The purpose of this form is to collect basic demographic 
information about the hospital and initiate the registration process.
    (2) Data Use Agreement--The purpose of the data use agreement, 
completed by the hospital POC, is to state how data submitted by 
hospitals will be used and provide privacy assurances.
    (3) Hospital Site Information Form--The purpose of the site 
information form, also completed by the hospital POC, is to collect 
background characteristics of the hospital. This information will be 
used to analyze data collected with the Hospital SOPS survey.
    (4) Data Files Submission--POCs upload their data file(s), using 
hospital data file specifications, to ensure that users submit 
standardized and consistent data in the way variables are named, coded, 
and formatted. The number of submissions to the database is likely to 
vary each year because hospitals do not administer the survey and 
submit data every year. Data submission is typically handled by one POC 
who is either a patient safety manager in the hospital or a survey 
vendor who contracts with a hospital to collect and submit their data. 
POCs submit data on behalf of 3 hospitals, on average, because many 
hospitals are part of a health system that includes many hospitals, or 
the POC is a vendor that is submitting data for multiple hospitals.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for the 
respondents' time to participate in the database. An estimated 340 
POCs, each representing an average of 3 individual hospitals each, will 
complete the database submission steps and forms annually. Each POC 
will submit the following:
     Eligibility and registration form (completion is estimated 
to take about 3 minutes).
     Data Use Agreement (completion is estimated to take about 
3 minutes).
     Hospital Information Form (completion is estimated to take 
about 5 minutes).
     Survey data submission will take an average of one hour.
    The total annual burden hours are estimated to be 459 hours. 
Exhibit 2 shows the estimated annualized cost burden based on the 
respondents' time to submit their data. The cost burden is estimated to 
be $26,572 annually.

                                  Exhibit 1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
                                                     Number of       Number of
                    Form name                      respondents/    responses per     Hours per     Total burden
                                                       POCs             POC          response          hours
----------------------------------------------------------------------------------------------------------------
Eligibility/Registration Form...................             340               1            3/60              17
Data Use Agreement..............................             340               1            3/60              17
Hospital Information Form.......................             340               3            5/60              85
Data Files Submission...........................             340               1               1             340
                                                 ---------------------------------------------------------------
    Total.......................................             N/A             N/A             N/A             459
----------------------------------------------------------------------------------------------------------------


                                   Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
                                                     Number of
                    Form name                      respondents/    Total burden   Average hourly    Total cost
                                                       POCs            hours        wage rate *       burden
----------------------------------------------------------------------------------------------------------------
Eligibility/Registration Form...................             340              17          $57.89            $984
Data Use Agreement..............................             340              17           57.89             984
Hospital Information Form.......................             340              85           57.89           4,921
Data Files Submission...........................             340             340           57.89          19,683
                                                 ---------------------------------------------------------------

[[Page 27123]]

 
    Total.......................................             N/A             N/A             N/A          26,572
----------------------------------------------------------------------------------------------------------------
* Mean hourly wage of $57.89 for Medical and Health Services Managers (SOC code 11-9111) was obtained from the
  May 2017 National Industry-Specific Occupational Employment and Wage Estimates NAICS 622000--Hospitals,
  located at http://www.bls.gov/oes/current/naics3_622000.htm.

Request for Comments

    In accordance with the Paperwork Reduction Act, comments on AHRQ's 
information collection are requested with regard to any of the 
following: (a) Whether the proposed collection of information is 
necessary for the proper performance of AHRQ's health care research and 
health care information dissemination functions, including whether the 
information will have practical utility; (b) the accuracy of AHRQ's 
estimate of burden (including hours and costs) of the proposed 
collection(s) of information; (c) ways to enhance the quality, utility 
and clarity of the information to be collected; and (d) ways to 
minimize the burden of the collection of information upon the 
respondents, including the use of automated collection techniques or 
other forms of information technology.
    Comments submitted in response to this notice will be summarized 
and included in the Agency's subsequent request for OMB approval of the 
proposed information collection. All comments will become a matter of 
public record.

Virginia L. Mackay-Smith,
Associate Director.
[FR Doc. 2019-12312 Filed 6-10-19; 8:45 am]
 BILLING CODE 4160-90-P