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Federal Register / Vol. 80, No. 149 / Tuesday, August 4, 2015 / Notices
proposed project or to obtain a copy of
the information collection plan and
instruments, contact the Information
Collection Review Office, Centers for
Disease Control and Prevention, 1600
Clifton Road NE., MS–D74, Atlanta,
Georgia 30329; phone: 404–639–7570;
Email: [email protected].

DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Disease Control and
Prevention
[60-Day–15–1006; Docket No. CDC–2015–
0061]

Proposed Data Collection Submitted
for Public Comment and
Recommendations
Centers for Disease Control and
Prevention (CDC), Department of Health
and Human Services (HHS).
ACTION: Notice with comment period.
AGENCY:

The Centers for Disease
Control and Prevention (CDC), as part of
its continuing efforts to reduce public
burden and maximize the utility of
government information, invites the
general public and other Federal
agencies to take this opportunity to
comment on proposed and/or
continuing information collections, as
required by the Paperwork Reduction
Act of 1995. This notice invites
comment on a proposed information
collection extension for the CDC Work@
Health® Program: Phase 2 Training and
Technical Assistance Evaluation. The
Work@Health® Program is a
comprehensive workplace training
program designed to improve employer
knowledge and skills related to
effective, science-based workplace
health programs, and support the
adoption of these programs in the
workplace.
DATES: Written comments must be
received on or before October 5, 2015.
ADDRESSES: You may submit comments,
identified by Docket No. CDC–2015–
0061 by any of the following methods:
Federal eRulemaking Portal:
Regulation.gov. Follow the instructions
for submitting comments.
Mail: Leroy A. Richardson,
Information Collection Review Office,
Centers for Disease Control and
Prevention, 1600 Clifton Road NE., MS–
D74, Atlanta, Georgia 30329.
Instructions: All submissions received
must include the agency name and
Docket Number. All relevant comments
received will be posted without change
to Regulations.gov, including any
personal information provided. For
access to the docket to read background
documents or comments received, go to
Regulations.gov.

tkelley on DSK3SPTVN1PROD with NOTICES

SUMMARY:

Please note: All public comment should be
submitted through the Federal eRulemaking
portal (Regulations.gov) or by U.S. mail to the
address listed above.
FOR FURTHER INFORMATION CONTACT:

To

request more information on the

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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. In addition, the PRA also
requires Federal agencies to provide a
60-day notice in the Federal Register
concerning each proposed collection of
information, including each new
proposed collection, each proposed
extension of existing collection of
information, and each reinstatement of
previously approved information
collection before submitting the
collection to OMB for approval. To
comply with this requirement, we are
publishing this notice of a proposed
data collection as described below.
Comments are invited on: (a) Whether
the proposed collection of information
is necessary for the proper performance
of the functions of the agency, including
whether the information shall have
practical utility; (b) the accuracy of the
agency’s estimate of the burden of the
proposed collection of information; (c)
ways to enhance the quality, utility, and
clarity of the information to be
collected; (d) ways to minimize the
burden of the collection of information
on respondents, including through the
use of automated collection techniques
or other forms of information
technology; and (e) estimates of capital
or start-up costs and costs of operation,
maintenance, and purchase of services
to provide information. Burden means
the total time, effort, or financial
resources expended by persons to
generate, maintain, retain, disclose or
provide information to or for a Federal
agency. This includes the time needed
to review instructions; to develop,
acquire, install and utilize technology
and systems for the purpose of
collecting, validating and verifying
information, processing and
maintaining information, and disclosing
and providing information; to train
personnel and to be able to respond to
a collection of information, to search
data sources, to complete and review
the collection of information; and to
transmit or otherwise disclose the
information.

SUPPLEMENTARY INFORMATION:

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Proposed Project
CDC Work@Health® Program: Phase 2
Training and Technical Assistance
Evaluation (OMB No. 0920–1006, exp.
date 1/31/2016)—Extension—National
Center for Chronic Disease Prevention
and Health Promotion (NCCDPHP),
Centers for Disease Control and
Prevention (CDC).
Background and Brief Description
In the United States, chronic diseases,
such as heart disease, obesity, and
diabetes are among the leading causes of
death and disability. Although chronic
diseases are among the most common
and costly health problems, they are
also among the most preventable.
Adopting healthy behaviors—such as
eating nutritious foods, being physically
active and avoiding tobacco use—can
prevent the devastating effects and
reduce the rates of these diseases.
Employers are recognizing the role
they can play in creating healthy work
environments and providing employees
with opportunities to make healthy
lifestyle choices. To support these
efforts, the Centers for Disease Control
and Prevention (CDC) developed the
Work@Health® Program, a
comprehensive worksite health training
program which includes the
development of a worksite health
training curriculum and delivery of
training to employers nationwide to
improve the health of workers and their
families. The Work@Health® Program is
authorized by the Public Health Service
Act and funded through the Prevention
and Public Health Fund of the Patient
Protection and Affordable Care Act
(ACA). The Work@Health® curriculum
uses a problem-solving approach to
improve employer knowledge and skills
related to effective, science-based
workplace health programs, and support
the adoption of these programs in the
workplace. Topics covered in the
Work@Health® curriculum include
principles, strategies, and tools for
leadership engagement; how to make a
business case for workplace health
programs; how to assess the needs of
organizations and individual
employees; how to plan, implement,
and evaluate sustainable workplace
health programs; and how to partner
with community organizations for
additional support.
CDC began the full-scale
implementation and evaluation of the
Work@Health® Program in Winter/
Spring 2014 (Work@Health® Program:
Phase 2 Training and Technical
Assistance Evaluation, OMB No. 0920–
1006, exp. date 1/31/2016). During the
initial two-year clearance period, the

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Federal Register / Vol. 80, No. 149 / Tuesday, August 4, 2015 / Notices
target number of trainees was 1,200.
Information was collected from trainees
and employers to support program
recruitment, implementation, and
evaluation.
CDC is requesting OMB approval to
extend information collection for three
years. There are no changes to
information collection methods or
instruments. The target number of new
trainees is 1,200. There are minor
changes to the burden table as a result
of annualizing responses over a threeyear period instead of a two-year period.
The expansion of the Work@Health®
program will foster the creation of farreaching networks to help develop a
sustainable worksite wellness network.
CDC will offer training in four models
(formats): (1) A ‘‘Hands-on’’ instructorled workshop model; (2) a self-paced
‘‘Online’’ model; (3) a combination or
‘‘Blended’’ model; and (4) a ‘‘Train-theTrainer’’ model designed to prepare
qualified individuals to train other
employers using the Work@Health®
curricula. Employers who complete the
Hands-on, Online, and Blended model
trainings will be invited to participate in
peer learning networks and receive
technical assistance from coaches to
support their efforts to implement or
enhance their workplace health

case studies. Outcome evaluation will
therefore include a descriptive
component as well as statistical models
to assess the extent to which the
program affected the target outcomes.
Employers will be recruited to
participate in the Work@Health®
training and evaluation scheduled to
begin in the Winter of 2016. The
training models will be evaluated by
assessing the participating employers’
changes in readiness to develop or
enhance a worksite health program;
environmental elements of the physical
worksite such as facilities; aggregate
employee participation in programs and
community partnership activities; and
elements of worksite structure,
practices, and policies related to health
and safety. CDC will also assess
trainees’ knowledge, attitudes, and
behaviors related to worksite health and
their reaction to the Work@Health®
training, including their satisfaction
with the training and opinions about
whether it met their needs. CDC will not
collect individual-level health data for
this project.
Participation is voluntary and there
are no costs to respondents other than
their time.

programs. Technical assistance will also
be provided to the individuals who
complete the Train-the-Trainer model to
help prepare them to provide the Work@
Health® training to employers. Training
graduates may be eligible for advanced
technical assistance and training from
CDC at a later date, through the
expanded Work@Health® Advance
Program.
To be eligible for the Hands-on,
Online, and Blended model trainings,
employers must have a minimum of 20
employees, a valid business license, and
have been in business for at least one
year. In addition, they must offer health
insurance to their employees and have
at least minimal workplace health
program knowledge and experience.
Applicants for the Train-the-Trainer
model must have previous knowledge,
training and experience with workplace
health programs and an interest in
becoming instructors for the Work@
Health® program. They may be referred
by employers, health departments,
business coalitions, trade associations,
or other organizations.
CDC will collect a combination of
qualitative and quantitative data
elements for analysis. These analyses
will be supplemented with interview
data collected for approximately six

ESTIMATED ANNUALIZED BURDEN HOURS

Interested Employer ..........................
Employers Participating in Work@
Health®.

Employer Application Form ..............
CDC Worksite Health Scorecard .....

400
320

1
1

20/60
30/60

133
160

Organizational Assessment .............
Employer Follow-up Survey .............
Case Study Interviews with Senior
Leadership.
Case Study Interviews with Employees.
Trainee KAB Survey ........................

320
160
2

1
1
1

15/60
15/60
1

80
40
2

4

1

1

4

640

1

20/60

213

Trainee Reaction Survey—HandsOn Model.
Trainee Reaction Survey—Online
Model.
Trainee Reaction Survey—Blended
Model.
Trainee Technical Assistance Survey.
Case Study Interviews with Selected Trainees.
Trainee Focus Group Discussion
Guide.
Train-the-Trainer Application Form ..

100

1

15/60

25

120

1

15/60

30

100

1

15/60

25

640

1

15/60

160

10

1

1

10

7

1

1.5

14

120

1

30/60

60

Train-the-Trainer Participant Survey

80

1

20/60

27

Trainee Reaction Survey—Trainthe-Trainer Model.
Train-the-Trainer Trainee Technical
Assistance Survey.

40

1

15/60

10

80

1

15/60

20

Interested Train-the-Trainer Participants.
Trainees Participating in the Work@
Health® Program (Train-the-Trainer model).

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Number of
respondents

Avg. burden
per response
(in hrs.)

Form name

Trainees Participating in the Work@
Health® Program (Hands-on, Online, Blended models).

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Number of
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Type of
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Federal Register / Vol. 80, No. 149 / Tuesday, August 4, 2015 / Notices
ESTIMATED ANNUALIZED BURDEN HOURS—Continued

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

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,
SUMMARY:

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Number of
respondents

Avg. burden
per response
(in hrs.)

Form name

Total ...........................................

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Number of
responses per
respondent

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:
[email protected].
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
http://www.cms.hhs.gov/Paperwork
ReductionActof1995.
2. Email your request, including your
address, phone number, OMB number,
and CMS document identifier, to
[email protected].
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

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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

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