Information Collection: NRC Form 995, Authorization for Use or Disclosure of Protected Health Information, 51558-51559 [2024-13322]

Download as PDF 51558 Federal Register / Vol. 89, No. 118 / Tuesday, June 18, 2024 / Notices For the Nuclear Regulatory Commission. David Cullison, NRC Clearance Officer, Office of the Chief Information Officer. [FR Doc. 2024–13320 Filed 6–17–24; 8:45 am] BILLING CODE 7590–01–P NUCLEAR REGULATORY COMMISSION [NRC–2023–0156] Information Collection: NRC Form 995, Authorization for Use or Disclosure of Protected Health Information Nuclear Regulatory Commission. ACTION: Proposed information collection; request for comment. AGENCY: The U.S. Nuclear Regulatory Commission (NRC) invites public comment on this proposed information collection. The information collection is entitled, NRC Form 995, ‘‘Authorization for Use or Disclosure of Protected Health Information.’’ DATES: Submit comments by August 19, 2024. Comments received after this date will be considered if it is practical to do so, but the Commission is able to ensure consideration only for comments received on or before this date. ADDRESSES: You may submit comments by any of the following methods; however, the NRC encourages electronic comment submission through the Federal rulemaking website: • Federal rulemaking website: Go to https://www.regulations.gov and search for Docket ID NRC–2023–0156. Address questions about Docket IDs in Regulations.gov to Stacy Schumann; telephone: 301–415–0624; email: Stacy.Schumann@nrc.gov. For technical questions, contact the individual listed in the FURTHER INFORMATION CONTACT section of this document. • Mail comments to: David Cullison, Office of the Chief Information Officer, Mail Stop: T–6 A10M, U.S. Nuclear Regulatory Commission, Washington, DC 20555–0001. For additional direction on obtaining information and submitting comments, see ‘‘Obtaining Information and Submitting Comments’’ in the SUPPLEMENTARY INFORMATION section of this document. FOR FURTHER INFORMATION CONTACT: David Cullison, Office of the Chief Information Officer, U.S. Nuclear Regulatory Commission, Washington, DC 20555–0001; telephone: 301–415– 2084; email: Infocollects.Resource@ nrc.gov. SUPPLEMENTARY INFORMATION: lotter on DSK11XQN23PROD with NOTICES1 SUMMARY: VerDate Sep<11>2014 17:57 Jun 17, 2024 Jkt 262001 I. Obtaining Information and Submitting Comments A. Obtaining Information Please refer to Docket ID NRC–2023– 0156 when contacting the NRC about the availability of information for this action. You may obtain publicly available information related to this action by any of the following methods: • Federal Rulemaking website: Go to https://www.regulations.gov and search for Docket ID NRC–2023–0156. A copy of the collection of information and related instructions may be obtained without charge by accessing Docket ID NRC–2023–0156 on this website. • NRC’s Agencywide Documents Access and Management System (ADAMS): You may obtain publicly available documents online in the ADAMS Public Documents collection at https://www.nrc.gov/reading-rm/ adams.html. To begin the search, select ‘‘Begin Web-based ADAMS Search.’’ For problems with ADAMS, please contact the NRC’s Public Document Room (PDR) reference staff at 1–800–397–4209, at 301–415–4737, or by email to PDR.Resource@nrc.gov. The supporting statement and NRC Form 995 are available in ADAMS under Accession Nos. ML23254A227 and ML23254A225. • NRC’s PDR: The PDR, where you may examine and order copies of publicly available documents, is open by appointment. To make an appointment to visit the PDR, please send an email to PDR.Resource@nrc.gov or call 1–800–397–4209 or 301–415– 4737, between 8 a.m. and 4 p.m. eastern time (ET), Monday through Friday, except Federal holidays. • NRC’s Clearance Officer: A copy of the collection of information and related instructions may be obtained without charge by contacting the NRC’s Clearance Officer, David Cullison, Office of the Chief Information Officer, U.S. Nuclear Regulatory Commission, Washington, DC 20555–0001; telephone: 301–415–2084; email: Infocollects.Resource@nrc.gov. B. Submitting Comments The NRC encourages electronic comment submission through the Federal rulemaking website (https:// www.regulations.gov). Please include Docket ID NRC–2023–0156, in your comment submission. The NRC cautions you not to include identifying or contact information in comment submissions that you do not want to be publicly disclosed in your comment submission. All comment submissions are posted at https:// www.regulations.gov and entered into ADAMS. Comment submissions are not PO 00000 Frm 00067 Fmt 4703 Sfmt 4703 routinely edited to remove identifying or contact information. If you are requesting or aggregating comments from other persons for submission to the NRC, then you should inform those persons not to include identifying or contact information that they do not want to be publicly disclosed in their comment submission. Your request should state that comment submissions are not routinely edited to remove such information before making the comment submissions available to the public or entering the comment into ADAMS. II. Background In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. chapter 35), the NRC is requesting public comment on its intention to request the OMB’s approval for the information collection summarized below. 1. The title of the information collection: NRC Form 995, Authorization for Use or Disclosure of Protected Health Information. 2. OMB approval number: An OMB control number has not yet been assigned to this proposed information collection. 3. Type of submission: New. 4. The form number, if applicable: NRC Form 995. 5. How often the collection is required or requested: Information is collected as needed. 6. Who will be required or asked to respond: Medical providers. 7. The estimated number of annual responses: 30. 8. The estimated number of annual respondents: 30. 9. The estimated number of hours needed annually to comply with the information collection requirement or request: 37.5. 10. Abstract: This clearance is being requested to collect information from an employee to authorize the agency’s medical reviewing authority to contact their private health provider. This authorization will be requested to determine and clarify disability status in the following situations: (1) an employee has requested reasonable accommodation and provided medical documentation; but further clarification or detail is needed to reach an appropriate determination on the request for accommodation; or (2) an employee is requesting extended health care coverage for a disabled adult dependent beyond the age otherwise covered. III. Specific Requests for Comments The NRC is seeking comments that address the following questions: E:\FR\FM\18JNN1.SGM 18JNN1 Federal Register / Vol. 89, No. 118 / Tuesday, June 18, 2024 / Notices 1. Is the proposed collection of information necessary for the NRC to properly perform its functions? Does the information have practical utility? Please explain your answer. 2. Is the estimate of the burden of the information collection accurate? Please explain your answer. 3. Is there a way to enhance the quality, utility, and clarity of the information to be collected? 4. How can the burden of the information collection on respondents be minimized, including the use of automated collection techniques or other forms of information technology? Dated: June 12, 2024. For the Nuclear Regulatory Commission. David Cullison, NRC Clearance Officer, Office of the Chief Information Officer. [FR Doc. 2024–13322 Filed 6–17–24; 8:45 am] BILLING CODE 7590–01–P PEACE CORPS Information Collection Request; Submission for OMB Review Peace Corps. 30-Day notice and request for comments. AGENCY: ACTION: The Peace Corps will be submitting the following information collection request to the Office of Management and Budget (OMB) for review and approval. The purpose of this notice is to allow 30 days for public comment in the Federal Register preceding submission to OMB. We are conducting this process in accordance with the Paperwork Reduction Act of 1995. SUMMARY: Submit comments on or before July 18, 2024. ADDRESSES: Comments should be addressed to James Olin, FOIA/Privacy Act Officer. James Olin can be contacted by phone 202–692–2507 or email at pcfr@peacecorps.gov. Email comments must be made in text and not in attachments. DATES: lotter on DSK11XQN23PROD with NOTICES1 FOR FURTHER INFORMATION CONTACT: James Olin, Peace Corps, at pcfr@ peacecorps.gov or by telephone at (202) 692–2507. SUPPLEMENTARY INFORMATION: Title: Individual Specific Medical Evaluation Forms (15). OMB Control Number: 0420–0550. Type of Request: Revision/New. Affected Public: Individuals/ Physicians. Respondents Obligation to Reply: Voluntary. VerDate Sep<11>2014 17:57 Jun 17, 2024 Jkt 262001 Respondents: Potential and current volunteers. Burden to the Public: • Asthma Evaluation Form (a) Estimated number of Applicants/ physicians 700/700 (b) Frequency of response one time (c) Estimated average burden per response 75 minutes/30 minutes (d) Estimated total reporting burden 875 hours/350 hours (e) Estimated annual cost to respondents Indeterminate General Description of Collection: When an Applicant reports on the Health History Form any history of asthma, he or she will be provided an Asthma Evaluation Form for the treating physician to complete The Asthma Evaluation Form asks for the physician to document the Applicant’s condition of asthma, including any asthma symptoms, triggers, treatments, or limitations or restrictions due to the condition. This form will be used as the basis for an individualized determination as to whether the Applicant will, with reasonable accommodation, be able to perform the essential functions of a Peace Corps Volunteer and complete a tour of service without unreasonable disruption due to health problems. This form will also be used to determine the type of accommodation that may be needed, such as placement of the Applicant within reasonable proximity to a hospital in case treatment is needed for a severe asthma attack. • Diabetes Diagnosis Form (a) Estimated number of Applicants/ physicians 55/55 (b) Frequency of response one time (c) Estimated average burden per response 75 minutes/30 minutes (d) Estimated total reporting burden 69 hours/28 hours (e) Estimated annual cost to respondents Indeterminate General Description of Collection: When an Applicant reports the condition of diabetes Type 1 on the Health History Form, the Applicant will be provided a Diabetes Diagnosis Form for the treating physician to complete. In certain cases, the Applicant may also be asked to have the treating physician complete a Diabetes Diagnosis Form if the Applicant reports the condition of diabetes Type 2 on the Health History Form. The Diabetes Diagnosis Form asks the physician to document the diabetes diagnosis, etiology, possible complications, and treatment. This form will be used as the basis for an individualized determination as to whether the Applicant will, with reasonable accommodation, be able to PO 00000 Frm 00068 Fmt 4703 Sfmt 4703 51559 perform the essential functions of a Peace Corps Volunteer assignment and complete a tour of service without unreasonable disruption due to health problems. This form will also be used to determine the type of accommodation that may be needed, such as placement of an Applicant who requires the use of insulin in order to ensure that adequate insulin storage facilities are available at the Applicant’s site. • Transfer of Care—Request for Information Form (a) Estimated number of Applicants/ physicians 1270/1270 (b) Frequency of response one time (c) Estimated average burden per response 75 minutes/30 minutes (d) Estimated total reporting burden 1588 hours/635 hours (e) Estimated annual cost to respondents Indeterminate General Description of Collection: When an Applicant reports on the Health History Form a medical condition of significant severity (other than one covered by another form), he or she may be provided the Transfer of Care—Request for Information Form for the treating physician to complete. The Transfer of Care—Request for Information Form may also be provided to an Applicant whose responses on the Health History Form indicate that the Applicant may have an unstable medical condition that requires ongoing treatment. The Transfer of Care— Request for Information Form asks the physician to document the diagnosis, current treatment, physical limitations and the likelihood of significant progression of the condition over the next three years. This form will be used as the basis for an individualized determination as to whether the Applicant will, with reasonable accommodation, be able to perform the essential functions of a Peace Corps Volunteer assignment and complete a tour of service without unreasonable disruption due to health problems. This form will also be used to determine the type of accommodation (e.g., avoidance of high altitudes or proximity to a hospital) that may be needed to manage the Applicant’s medical condition. • Mental Health Current Evaluation and Treatment Summary Form (a) Estimated number of Applicants/ professional 1221/1221 (b) Frequency of response one time (c) Estimated average burden per response 105 minutes/60 minutes (d) Estimated total reporting burden 2137 hours/1221 hours (e) Estimated annual cost to respondents Indeterminate General Description of Collection: The Mental Health Current Evaluation Form E:\FR\FM\18JNN1.SGM 18JNN1

Agencies

[Federal Register Volume 89, Number 118 (Tuesday, June 18, 2024)]
[Notices]
[Pages 51558-51559]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-13322]


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NUCLEAR REGULATORY COMMISSION

[NRC-2023-0156]


Information Collection: NRC Form 995, Authorization for Use or 
Disclosure of Protected Health Information

AGENCY: Nuclear Regulatory Commission.

ACTION: Proposed information collection; request for comment.

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

SUMMARY: The U.S. Nuclear Regulatory Commission (NRC) invites public 
comment on this proposed information collection. The information 
collection is entitled, NRC Form 995, ``Authorization for Use or 
Disclosure of Protected Health Information.''

DATES: Submit comments by August 19, 2024. Comments received after this 
date will be considered if it is practical to do so, but the Commission 
is able to ensure consideration only for comments received on or before 
this date.

ADDRESSES: You may submit comments by any of the following methods; 
however, the NRC encourages electronic comment submission through the 
Federal rulemaking website:
     Federal rulemaking website: Go to https://www.regulations.gov and search for Docket ID NRC-2023-0156. Address 
questions about Docket IDs in Regulations.gov to Stacy Schumann; 
telephone: 301-415-0624; email: [email protected]. For technical 
questions, contact the individual listed in the FURTHER INFORMATION 
CONTACT section of this document.
     Mail comments to: David Cullison, Office of the Chief 
Information Officer, Mail Stop: T-6 A10M, U.S. Nuclear Regulatory 
Commission, Washington, DC 20555-0001.
    For additional direction on obtaining information and submitting 
comments, see ``Obtaining Information and Submitting Comments'' in the 
SUPPLEMENTARY INFORMATION section of this document.

FOR FURTHER INFORMATION CONTACT: David Cullison, Office of the Chief 
Information Officer, U.S. Nuclear Regulatory Commission, Washington, DC 
20555-0001; telephone: 301-415-2084; email: 
[email protected].

SUPPLEMENTARY INFORMATION:

I. Obtaining Information and Submitting Comments

A. Obtaining Information

    Please refer to Docket ID NRC-2023-0156 when contacting the NRC 
about the availability of information for this action. You may obtain 
publicly available information related to this action by any of the 
following methods:
     Federal Rulemaking website: Go to https://www.regulations.gov and search for Docket ID NRC-2023-0156. A copy of 
the collection of information and related instructions may be obtained 
without charge by accessing Docket ID NRC-2023-0156 on this website.
     NRC's Agencywide Documents Access and Management System 
(ADAMS): You may obtain publicly available documents online in the 
ADAMS Public Documents collection at https://www.nrc.gov/reading-rm/adams.html. To begin the search, select ``Begin Web-based ADAMS 
Search.'' For problems with ADAMS, please contact the NRC's Public 
Document Room (PDR) reference staff at 1-800-397-4209, at 301-415-4737, 
or by email to [email protected]. The supporting statement and NRC 
Form 995 are available in ADAMS under Accession Nos. ML23254A227 and 
ML23254A225.
     NRC's PDR: The PDR, where you may examine and order copies 
of publicly available documents, is open by appointment. To make an 
appointment to visit the PDR, please send an email to 
[email protected] or call 1-800-397-4209 or 301-415-4737, between 8 
a.m. and 4 p.m. eastern time (ET), Monday through Friday, except 
Federal holidays.
     NRC's Clearance Officer: A copy of the collection of 
information and related instructions may be obtained without charge by 
contacting the NRC's Clearance Officer, David Cullison, Office of the 
Chief Information Officer, U.S. Nuclear Regulatory Commission, 
Washington, DC 20555-0001; telephone: 301-415-2084; email: 
[email protected].

B. Submitting Comments

    The NRC encourages electronic comment submission through the 
Federal rulemaking website (https://www.regulations.gov). Please 
include Docket ID NRC-2023-0156, in your comment submission.
    The NRC cautions you not to include identifying or contact 
information in comment submissions that you do not want to be publicly 
disclosed in your comment submission. All comment submissions are 
posted at https://www.regulations.gov and entered into ADAMS. Comment 
submissions are not routinely edited to remove identifying or contact 
information.
    If you are requesting or aggregating comments from other persons 
for submission to the NRC, then you should inform those persons not to 
include identifying or contact information that they do not want to be 
publicly disclosed in their comment submission. Your request should 
state that comment submissions are not routinely edited to remove such 
information before making the comment submissions available to the 
public or entering the comment into ADAMS.

II. Background

    In accordance with the Paperwork Reduction Act of 1995 (44 U.S.C. 
chapter 35), the NRC is requesting public comment on its intention to 
request the OMB's approval for the information collection summarized 
below.
    1. The title of the information collection: NRC Form 995, 
Authorization for Use or Disclosure of Protected Health Information.
    2. OMB approval number: An OMB control number has not yet been 
assigned to this proposed information collection.
    3. Type of submission: New.
    4. The form number, if applicable: NRC Form 995.
    5. How often the collection is required or requested: Information 
is collected as needed.
    6. Who will be required or asked to respond: Medical providers.
    7. The estimated number of annual responses: 30.
    8. The estimated number of annual respondents: 30.
    9. The estimated number of hours needed annually to comply with the 
information collection requirement or request: 37.5.
    10. Abstract: This clearance is being requested to collect 
information from an employee to authorize the agency's medical 
reviewing authority to contact their private health provider. This 
authorization will be requested to determine and clarify disability 
status in the following situations: (1) an employee has requested 
reasonable accommodation and provided medical documentation; but 
further clarification or detail is needed to reach an appropriate 
determination on the request for accommodation; or (2) an employee is 
requesting extended health care coverage for a disabled adult dependent 
beyond the age otherwise covered.

III. Specific Requests for Comments

    The NRC is seeking comments that address the following questions:

[[Page 51559]]

    1. Is the proposed collection of information necessary for the NRC 
to properly perform its functions? Does the information have practical 
utility? Please explain your answer.
    2. Is the estimate of the burden of the information collection 
accurate? Please explain your answer.
    3. Is there a way to enhance the quality, utility, and clarity of 
the information to be collected?
    4. How can the burden of the information collection on respondents 
be minimized, including the use of automated collection techniques or 
other forms of information technology?

    Dated: June 12, 2024.

    For the Nuclear Regulatory Commission.
David Cullison,
NRC Clearance Officer, Office of the Chief Information Officer.
[FR Doc. 2024-13322 Filed 6-17-24; 8:45 am]
BILLING CODE 7590-01-P
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