Attachment B -- Federal Register Notice

Federal Register / Vol. 74, No. 49 / Monday, March 16, 2009 / Notices
similarly revised to include the current
credit exposure arising from credit
derivative contracts that represent (a)
purchased protection that is defined as
a covered position under the market risk
capital guidelines and (b) purchased
protection that is not a covered position
under the market risk capital guidelines
and is not recognized as a guarantee for
risk-based capital purposes. The Federal
Reserve also proposed to add new
Memorandum items 3.a and 3.b to
Schedule HC–R to collect the present
value of unpaid premiums on sold
credit protection that is defined as a
covered position under the market risk
capital guidelines. Consistent with the
information currently reported in
Memorandum item 2.g, the Federal
Reserve proposed to collect this present
value information with a breakdown
between investment grade and
subinvestment grade for the rating of the
underlying reference asset and with the
same three remaining maturity
breakouts.
No comments were received on any of
the proposed reporting revisions
pertaining to credit derivatives
described above, except for a comment
from a bankers’ organization on the
proposal to collect data on Schedule
HC–R relating to the present value of
unpaid premiums on sold credit
protection that is defined as a covered
position under the market risk capital
guidelines. Accordingly, the Federal
Reserve will implement all of the
proposed credit derivative reporting
changes—other than the proposed new
Schedule HC–R data items for present
value data—as of June 30, 2009, as
proposed. With respect to the present
value data, the bankers’ organization
requested clarification of the impact of
this proposed reporting requirement on
a banking institution’s risk-based capital
calculations. The Federal Reserve is
continuing to consider this comment
and the proposed collection of present
value data for certain credit derivatives.
Therefore, the Federal Reserve will not
add Memorandum items 3.a and 3.b to
Schedule HC–R to collect this present
value information effective June 30,
2009, as proposed. Once deliberations
on the comment and the proposed
present value data items have been
concluded, conclusions will be
published in a separate Federal Register
notice. If Memorandum items 3.a and
3.b are subsequently added to Schedule
HC–R, this new reporting requirement
would take effect no earlier than
December 31, 2009.

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Board of Governors of the Federal Reserve
System, March 11, 2009.
Jennifer J. Johnson,
Secretary of the Board.
[FR Doc. E9–5584 Filed 3–13–09; 8:45 am]
BILLING CODE 6210–01–P

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:
‘‘Improving Patient Flow and Reducing
Emergency Department Crowding.’’ In
accordance with the Paperwork
Reduction Act of 1995, 44 U.S.C.
3506(c)(2)(A), AHRQ invites the public
to comment on this proposed
information collection.
This proposed information collection
was previously published in the Federal
Register on January 15th, 2009 and
allowed 60 days for public comment.
One comment was received. The
purpose of this notice is to allow an
additional 30 days for public comment.
DATES: Comments on this notice must be
received by April 15, 2009.
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).
Copies of the proposed collection
plans, data collection instruments, and
specific details on the estimated burden
can be obtained from the AHRQ Reports
Clearance Officer.
FOR FURTHER INFORMATION CONTACT:
Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427–1477, or by
e-mail at doris.lefkowitz@ahrq.hhs.gov.
SUPPLEMENTARY INFORMATION:

Proposed Project
‘‘Improving Patient Flow and
Reducing Emergency Department
Crowding’’ AHRQ proposes to study
implementation of strategies from the
Urgent Matters (UM) Toolkit for
improving patient flow in emergency

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11109

departments (ED). UM, a Robert Wood
Johnson Foundation (RWJF) funded
initiative, began as a collaborative of 10
urban, safety net hospitals that
experimented with a variety of strategies
(now included in the ‘‘UM Toolkit’’)
designed to relieve ED crowding. The
first phase of this initiative
demonstrated that reductions in ED
crowding were achievable without
investment of significant financial
resources. However, implementation of
these strategies has not been
widespread, and questions remain about
how readily the strategies could be
implemented in a more diverse group of
hospitals, and the associated costs and
outcomes of implementation. This study
is funded by a grant from RWJF to
AHRQ.
Six diverse hospitals have been
selected for this study of the
implementation of strategies from the
UM Toolkit for improving ED patient
flow. This study poses a common
outcome goal across all six sites of
improving patient flow and reducing ED
crowding, but requires each hospital to
select strategies that fit its own needs
and context. This approach rests on
innovation research showing that
organizational innovations are more
successful when they are aligned with
features of the adopting hospital.
Participating hospitals will select
strategies from the UM Toolkit that they
believe will work best to address the
particular problems they face. The six
hospitals have agreed to participate in a
collaborative run by the UM National
Program Office (NPO) over the course of
this study to facilitate the sharing of
data and experiences while the project
is underway.
This study will document the
experiences of a diverse set of hospital
EDs as they identify and implement ED
patient flow improvement strategies.
The six case study hospitals were
selected to reflect diversity of size,
ownership, teaching status, safety net
status, and types of challenges with ED
crowding.
Research methods will include
observational site visits, in-person and
telephone interviews, and the analysis
of cost data. AHRQ’s contractor for this
study, Health Research & Educational
Trust (HRET), will perform analysis of
secondary data on ED performance
measures; this secondary data will be
provided to HRET by the Urgent Matters
NPO. These qualitative and quantitative
methods will be used to:
• Study the processes through which
hospitals decide upon and adopt patient
flow improvement strategies;

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Federal Register / Vol. 74, No. 49 / Monday, March 16, 2009 / Notices

• Identify facilitators and barriers to
the implementation and maintenance of
these strategies;
• Document changes in patient flow,
patient satisfaction, and staff
satisfaction associated with the
implementation of strategies and
processes;
• Generate estimates of the costs of
adopting the strategies;
• Identify issues associated with the
reporting of ED performance measures;
and,
• Develop lessons for hospitals
considering the adoption of patient flow
improvement strategies.
The study will not be used to answer
questions about causality or degrees of
effectiveness (e.g., to what degree did a
given intervention cause an
improvement in patient flow?). Rather,
the study seeks to enhance
understanding of factors affecting
decision-making and adoption processes
that facilitate or hinder implementation.
Insights and lessons learned about

organizational, technical and resource
challenges arising from these
improvement activities may be of
interest or benefit to others seeking to
identify and adopt strategies to address
similar problems in their EDs.
This study is being conducted
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 health care
services; quality measurement and
improvement; and health care costs,
productivity, organization, and market
forces. 42 U.S.C. 299a(a)(1), (2), and (6).
Method of Collection
AHRQ seeks approval for the
following data collection activities:
In-person interviews will be
conducted within two months of the
implementation with up to 12
individuals at each of the 6 sites during

two-day site visits to each of the
hospitals.
Telephone interviews will be
conducted approximately 6 months after
implementation with 12 individuals
from each of the six hospitals (most or
all of whom will be the same
individuals interviewed in person).
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated
annualized burden hours for the
hospitals’ time to participate in this
study. In-person interviews will be
conducted within two months of
implementation with 12 administrative
and clinical personnel from each of the
six participating hospitals and will
require about one hour. Telephone
interviews will be conducted
approximately six months thereafter
with 12 individuals (administrative and
clinical) from each hospital and will
take about 45 minutes. The total
estimated burden for participation in
this study is 126 hours.

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS
Number of
responses per
hospital

Number of
hospitals

Data collection

Hours per
response

Total burden
hours

In-person interviews .........................................................................................
Telephone interviews .......................................................................................

6
6

12
12

1.0
45/60

72
54

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

12

na

na

126

Exhibit 2 shows the estimated
annualized cost burden for the
respondents’ time to provide the

requested data. The total cost burden is
approximately $4,419.

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN
Total burden
hours

Data collection

Average
hourly wage
rate *

Total cost
burden

In-person interviews .....................................................................................................................
Telephone interviews ...................................................................................................................

72
54

$35.07
$35.07

$2,525
1,894

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

126

na

4,419

* For the interviews, the hourly rate of $35.07 is an average of the admini strative personnel hourly wage of $14.53, the physician rate of
$62.52, and the registered nurse rate of $28.15. National Compensation Survey: Occupational Wages in the United States 2005, U.S. Department of Labor, Bureau of Labor Statistics.

Estimated Annual Costs to the Federal
Government
Exhibit 3 shows the total and
annualized cost to the government for
this eighteen-month study.

EXHIBIT 3—ESTIMATED COST
Cost component

Total cost

Project Development ...............................................................................................................................................
Data Collection Activities .........................................................................................................................................

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52,446
90,298

Annualized
cost
34,964
60,199

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Federal Register / Vol. 74, No. 49 / Monday, March 16, 2009 / Notices
EXHIBIT 3—ESTIMATED COST—Continued
Cost component

Total cost

Annualized
cost

Data Processing and Analysis .................................................................................................................................
Publication of Results ..............................................................................................................................................
Project Management ................................................................................................................................................
Overhead .................................................................................................................................................................

70,569
41,420
68,908
76,320

47,046
27,613
45,939
50,880

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

$399,961

266,641

Request for Comments
In accordance with the above-cited
Paperwork Reduction Act legislation,
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.
Dated: March 9, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E9–5581 Filed 3–13–09; 8:45 am]
BILLING CODE 4160–90–M

DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Agency for Healthcare Research and
Quality
Meeting of the National Advisory
Council for Healthcare Research and
Quality
AGENCY: Agency for Healthcare Research
and Quality (AHRQ).
ACTION: Notice of public meeting.
SUMMARY: In accordance with section
10(a) of the Federal Advisory Committee
Act, 5 U.S.C. app. 2, this notice
announces a meeting of the National

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Advisory Council for Healthcare
Research and Quality.
DATES: The meeting will be held on
Friday, April 3, 2009, from 9 a.m. to 3
p.m.
ADDRESSES: The meeting will be held at
the Eisenberg Conference Center,
Agency for Healthcare Research and
Quality, 540 Gaither Road, Rockville,
Maryland 20850.
FOR FURTHER INFORMATION CONTACT:
Deborah Queenan, Coordinator of the
Advisory Council, at the Agency for
Healthcare Research and Quality, 540
Gaither Road, Rockville, Maryland
20850, (301) 427–1330. For press-related
information, please contact Karen
Migdail at (301) 427–1855.
If sign language interpretation or other
reasonable accommodation for a
disability is needed, please contact Mr.
Donald L. Inniss, Director, Office of
Equal Employment Opportunity
Program, Program Support Center, on
(301) 443–1144, no later than March 27,
2009. The agenda, roster, and minutes
are available from Ms. Bonnie Campbell,
Committee Management Officer, Agency
for Healthcare Research and Quality,
540 Gaither Road, Rockville, Maryland
20850. Ms. Campbell’s phone number is
(301) 427–1554.
SUPPLEMENTARY INFORMATION:
I. Purpose
The National Advisory Council for
Healthcare Research and Quality was
established in accordance with Section
921 (now Section 931) of the Public
Health Service Act, 42 U.S.C. 299c. In
accordance with its statutory mandate,
the Council is to advise the Secretary of
the Department of Health and Human
Services and the Director, Agency for
Healthcare Research and Quality
(AHRQ), on matters related to actions of
AHRQ to enhance the quality, improve
the outcomes, and reduce the costs of
health care services; improve access to
such services through scientific
research; and promote improvements in
clinical practice and in the organization,
financing, and delivery of health care
services.
The Council is composed of members
of the public, appointed by the

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Secretary, and Federal ex-officio
members.
II. Agenda
On Friday, April 3, the Council
meeting will convene at 9 a.m., with the
call to order by the Council Chair and
approval of previous Council minutes.
The AHRQ director will present her
update on current research, programs,
and initiatives. The agenda will include
a discussion of AHRQ budget for FY09,
the comparative effectiveness program,
and the AHRQ activities under
American Recovery and Reinvestment
Act (ARRA).
The final agenda will be available on
the AHRQ Web site at http://
www.ahrg.gov no later than March 30,
2009.
Dated: March 9, 2009.
Carolyn M. Clancy,
Alternate Certifying Officer Director.
[FR Doc. E9–5580 Filed 3–13–09; 8:45 am]
BILLING CODE 4160–90–M

DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Disease Control and
Prevention
Subcommittee on Procedures
Reviews, Advisory Board on Radiation
and Worker Health (ABRWH), National
Institute for Occupational Safety and
Health (NIOSH)
In accordance with section 10(a)(2) of
the Federal Advisory Committee Act
(Pub. L. 92–463), CDC announces the
following meeting for the
aforementioned subcommittee:
Time and Date: 10 a.m.–5 p.m., March 24,
2009.
Place: Cincinnati Airport Marriott, 2395
Progress Drive, Hebron, Kentucky 41018.
Telephone (859) 334–4611, Fax (859) 334–
4619.
Status: Open to the public, but without a
public oral comment period. To access by
conference call dial the following
information 1 (866) 659–0537, Participant
Pass Code 9933701.
Background: The Advisory Board was
established under the Energy Employees
Occupational Illness Compensation Program

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