[Federal Register Volume 78, Number 157 (Wednesday, August 14, 2013)]
[Notices]
[Pages 49530-49532]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-19648]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Resources and Services Administration


Agency Information Collection Activities: Submission to OMB for 
Review and Approval; Public Comment Request

AGENCY: Health Resources and Services Administration, HHS.

ACTION: Notice.

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SUMMARY: In compliance with Section 3507(a)(1)(D) of the Paperwork 
Reduction Act of 1995, the Health Resources and Services Administration 
(HRSA) has submitted an Information Collection Request (ICR) to the 
Office of Management and Budget (OMB) for review and approval. Comments 
submitted during the first public review of this ICR will be provided 
to OMB. OMB will accept further comments from the public during the 
review and approval period.

DATES: Comments on this ICR should be received within 30 days of this 
notice.

[[Page 49531]]


ADDRESSES: Submit your comments, including the Information Collection 
Request Title, to the desk officer for HRSA, either by email to [email protected] or by fax to 202-395-5806.

FOR FURTHER INFORMATION CONTACT: To request a copy of the clearance 
requests submitted to OMB for review, email the HRSA Information 
Collection Clearance Officer at [email protected] or call (301) 443-
1984.
    Information Collection Request Title: Request for Benefits Form--
Optional Collection of Additional Medical Records, Collection of 
Benefits Determination Documentation OMB No. 0915-0334--Revision
    Abstract: This is a revision to the request for OMB approval of the 
information collection requirements for the Countermeasures Injury 
Compensation Program (CICP). The CICP, within the Health Resources and 
Services Administration (HRSA), administers the compensation program 
authorized by the Public Readiness and Emergency Preparedness Act (PREP 
Act). The CICP provides compensation to eligible individuals 
(requesters) who suffer serious injuries directly caused by a covered 
countermeasure administered or used pursuant to a PREP Act Declaration, 
or to their estates and/or survivors. A declaration is issued by the 
Secretary of the Department of Health and Human Services (Secretary). 
The purpose of a declaration is to identify a disease, health 
condition, or a threat to health that is currently, or may in the 
future constitute, a public health emergency. In addition, the 
Secretary, through a declaration, may recommend and encourage the 
development, manufacturing, distribution, dispensing, and 
administration or use of one or more covered countermeasures to treat, 
prevent, or diagnose the disease, condition, or threat specified in the 
declaration.
    To determine whether a requester is eligible for CICP benefits 
(compensation) for the injury, the CICP must review the Request for 
Benefits Package, which includes the Request for Benefits Form and 
Authorization for Use or Disclosure of Health Information Form(s), as 
well as the injured countermeasure recipient's medical records and 
supporting documentation.
    A requester who is an injured countermeasure recipient may be 
eligible to receive benefits for unreimbursed medical expenses and/or 
lost employment income. The estate of a deceased countermeasure 
recipient may also be eligible to receive medical benefits and/or 
benefits for lost employment income accrued prior to the injured 
countermeasure recipient's death. If death was the result of the 
administration or use of the countermeasure, certain survivor(s) of 
deceased eligible countermeasure recipients may be eligible to receive 
a death benefit, but not unreimbursed medical expenses or lost 
employment income benefits. 42 CFR Sec.  110.33. The death benefit is 
calculated using either the ``standard calculation'' or the 
``alternative calculation.'' The ``standard calculation'' is based on 
the death benefit available under the Public Safety Officers' Benefits 
(PSOB) Program. 42 CFR 110.82(b). The ``alternative calculation'' is 
based on the deceased countermeasure recipient's income and is only 
available to the recipient's dependent(s) who is (are) younger than age 
18. 42 CFR 110.82(c).
    Approval is requested for the required continued information 
collection via the Request for Benefits Package, which has been updated 
to include all categories of potentially eligible requesters, including 
adult children, so that the CICP may continue to accept and process 
requests for benefits. The Request for Benefits Form and Instructions 
have been revised to remove the request for a Social Security number, 
update the CICP Web site address, and add a new category of eligible 
requesters, adult children. This new category was added because the 
CICP is generally required to use the same categories of survivors and 
order of priority for benefits as established and defined by the PSOB 
Program. 42 CFR 110.11(b). This new category of survivors was added 
under the PSOB Program.
    Approval is requested for new mechanisms of obtaining medical 
documentation and supporting documentation collection. During the 
eligibility review, the CICP would like to provide requesters with the 
opportunity to supplement their case files with additional medical 
records and supporting documentation before a final determination is 
made. The CICP would ask requesters to complete and sign a form 
indicating whether they intend to submit additional documentation prior 
to the final determination of their case.
    Approval is requested for a benefits documentation package the CICP 
plans to send to requesters who may be eligible for compensation which 
includes certification forms and instructions outlining the 
documentation needed to determine the types and amounts of benefits. 
This documentation is required under 42 CFR 110.61-110.63 of the CICP's 
implementing regulations to enable the CICP to determine the types and 
amounts of benefits the requester may be eligible to receive.
    Need and Proposed Use of the Information: The information collected 
from requesters to the CICP provides data and documentation that is 
needed for the Program to determine: (1) The requester's eligibility to 
receive benefits; and (2) if applicable, the type and amount of 
benefits that may be awarded.
    Burden Statement: Burden in this context means the time expended by 
persons to generate, maintain, retain, disclose or provide the 
information requested. 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. The total annual burden hours estimated for 
this ICR are summarized in the table below.

                                    Total Estimated Annualized Burden--Hours
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                                                                                       Average
                                       Number of       Number of         Total        burden per    Total burden
             Form name                respondents    responses per     responses     response (in      hours
                                                      respondent                        hours)
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Request for Benefits Form and                  100               1             100         11            1100
 Supporting Documentation.........
Authorization for Use or                       100               1             100          2             200
 Disclosure of Health Information
 Form.............................
Additional Documentation and                    30               1              30           .75           22.5
 Certification....................
Benefits Package and Supporting                 30               1              30           .125           3.75
 Documentation....................

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    Total.........................             100  ..............  ..............  .............        1326.25
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    Dated: August 6, 2013.
Bahar Niakan,
Director, Division of Policy and Information Coordination.
[FR Doc. 2013-19648 Filed 8-13-13; 8:45 am]
BILLING CODE 4165-15-P