2011-32123. Agency Information Collection Request. 30-Day Public Comment Request

AGENCY:

Office of the Secretary, HHS.

In compliance with the requirement of section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Office of the Secretary (OS), Department of Health and Human Services, is publishing the following summary of a proposed collection for public comment. Interested persons are invited to send comments regarding this 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.

To obtain copies of the supporting statement and any related forms for the proposed paperwork collections referenced above, email your request, including your address, phone number, OMB number, and OS document identifier, to [e-mail], or call the Reports Clearance Office on [phone]. Send written comments and recommendations for the proposed information collections within 30 days of this notice directly to the OS OMB Desk Officer; faxed to OMB at [phone].

Proposed Project: Patient Centered Care Collaboration to Improve Minority Health, OMB# 0990-New, Office of Minority Health.

Abstract: The Office of Minority Health (OMH) in the Office of the Assistant Secretary for Health (OASH), Office of the Secretary (OS) is requesting approval from the Office of Management and Budget (OMB) on new data collection activities for the Patient Centered Care Collaboration to Improve Minority Health project (PCCC). This dissemination and adoption initiative funded in 2010, under the ARRA, 2009, through the Office of Minority Health and the Agency for Health Care Quality supports dissemination and adoption priorities as outlined in the HHS Report to Congress on Comparative Effectiveness Research. The PCCC evaluation will assess whether disseminating a diabetes education intervention in a community based health clinic and offering a medication management and adherence intervention through home visits to seniors, improves the health and well being of racial and ethnic minority program participants; if the approach taken through the implementation of proven PCOR findings such as using community health workers and educators, and pharmacists to deliver the interventions improves the likelihood of patients changing their behaviors to improve their health status; and to determine if participants learned new information and skills that would help them to manage their health conditions and improve their health status.

Estimated Annualized Burden Table

Forms	Type of respondent	Number of respondents	Number of responses per respondent	Average burden (in hours) per response	Total burden hours
Chicago:
Screening Questionnaire	Individuals	165	1	5/60	14
Intake Questionnaire	Individuals	50	1	40/60	33
Post Questionnaire	Individuals	40	1	40/60	27
Sub-Total		255	1		74
Houston:
Eligibility Screening Form: Hypertension and Diabetes	Individual	200	1	15/60	50
First Home Visit Forms: Hypertension, Diabetes, or Hypertension and Diabetes	Individual	200	1	40/60	133
Telephone Follow-up: Being Active and Managing Stress	Individual	180	1	20/60	60
Telephone Follow-up: Healthy Eating	Individual	180	1	20/60	60
Post Intervention Follow-up Form: Hypertension, Diabetes, or Hypertension and Diabetes	Individual	180	1	20/60	60
Sub-total		940			363
Total	Individual	1195			437

Keith A. Tucker,

Office of the Secretary, Paperwork Reduction Act Clearance Officer.