81_FR_90188 81 FR 89949 - Agency Information Collection Activities; Submission for Office of Management and Budget Review; Comment Request; Donor Risk Assessment Questionnaire for the Food and Drug Administration/National Heart, Lung, and Blood Institute-Sponsored Transfusion-Transmissible Infections Monitoring System-Risk Factor Elicitation

81 FR 89949 - Agency Information Collection Activities; Submission for Office of Management and Budget Review; Comment Request; Donor Risk Assessment Questionnaire for the Food and Drug Administration/National Heart, Lung, and Blood Institute-Sponsored Transfusion-Transmissible Infections Monitoring System-Risk Factor Elicitation

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration

Federal Register Volume 81, Issue 239 (December 13, 2016)

Page Range89949-89950
FR Document2016-29814

The Food and Drug Administration (FDA) is announcing that a proposed collection of information has been submitted to the Office of Management and Budget (OMB) for review and clearance under the Paperwork Reduction Act of 1995.

Federal Register, Volume 81 Issue 239 (Tuesday, December 13, 2016)
[Federal Register Volume 81, Number 239 (Tuesday, December 13, 2016)]
[Notices]
[Pages 89949-89950]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2016-29814]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

[Docket No. FDA-2016-N-2836]


Agency Information Collection Activities; Submission for Office 
of Management and Budget Review; Comment Request; Donor Risk Assessment 
Questionnaire for the Food and Drug Administration/National Heart, 
Lung, and Blood Institute-Sponsored Transfusion-Transmissible 
Infections Monitoring System--Risk Factor Elicitation

AGENCY: Food and Drug Administration, HHS.

ACTION: Notice.

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

SUMMARY: The Food and Drug Administration (FDA) is announcing that a 
proposed collection of information has been submitted to the Office of 
Management and Budget (OMB) for review and clearance under the 
Paperwork Reduction Act of 1995.

DATES: Fax written comments on the collection of information by January 
12, 2017.

ADDRESSES: To ensure that comments on the information collection are 
received, OMB recommends that written comments be faxed to the Office 
of Information and Regulatory Affairs, OMB, Attn: FDA Desk Officer, 
FAX: 202-395-7285, or emailed to [email protected]. All 
comments should be identified with the OMB control number 0910--New and 
title ``Donor Risk Assessment Questionnaire for the Food and Drug 
Administration/National Heart, Lung, and Blood Institute-sponsored 
Transfusion-Transmissible Infections Monitoring System--Risk Factor 
Elicitation.'' Also include the FDA docket number found in brackets in 
the heading of this document.

FOR FURTHER INFORMATION CONTACT: FDA PRA Staff, Office of Operations, 
Food and Drug Administration, Three White Flint North, 10A63, 11601 
Landsdown St., North Bethesda, MD 20852, [email protected].

SUPPLEMENTARY INFORMATION: In compliance with 44 U.S.C. 3507, FDA has 
submitted the following proposed collection of information to OMB for 
review and clearance.
    Donor Risk Assessment Questionnaire for FDA/National Heart, Lung, 
and Blood Institute (NHLBI)-sponsored Transfusion-Transmissible 
Infections Monitoring System (TTIMS)--Risk Factor Elicitation OMB 
Control Number--New
    FDA intends to interview blood donors to collect risk factor 
information associated with testing positive for a Transfusion-
Transmissible Infection (TTI). This collection of information is part 
of a larger initiative called TTIMS, which is a collaborative project 
funded by FDA, the NHLBI of the National Institutes of Health (NIH), 
and the Department of Health and Human Services (HHS) Office of the 
Assistant Secretary of Health with input from other Agencies in HHS, 
including the Centers for Disease Control and Prevention (CDC). FDA 
will use these scientific data collected through such interview-based 
risk factor elicitation of blood donors to monitor and help ensure the 
safety of the U.S. blood supply.
    Previous assessments of risk factor profiles among blood donors 
found to be positive for human immunodeficiency virus (HIV) were funded 
by CDC for approximately 10 years after implementation of HIV serologic 
screening of blood donors in the mid-1980s; whereas studies of 
Hepatitis C virus (HCV) seropositive donors, funded by NIH, were 
conducted in the early 1990s. Information on current risk factors in 
blood donors as assessed using analytical study designs was next 
evaluated by the Transfusion-Transmitted Retrovirus and Hepatitis Virus 
Rates and Risk Factors Study conducted by the NHLBI Retrovirus 
Epidemiology Donor Study-II (REDS-II) approved under OMB control number 
0925-0630. Through a risk factor questionnaire, this study elicited 
risk factors in blood donors who tested confirmed positive for one of 
four transfusion-transmissible infections: HIV, HCV, Hepatitis B virus 
(HBV), and Human T-cell Lymphotropic virus. The study also elicited 
risk factors from donors who did not have any infections (controls) and 
compared their responses to those of the donors with confirmed 
infection (cases). Results from the REDS-II study were published in 
2015.
    FDA issued a document entitled ``Revised Recommendations for 
Reducing the Risk of Human Immunodeficiency Virus Transmission by Blood 
and Blood Products, Guidance for Industry'' dated December 2015 (http://www.fda.gov/downloads/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/Blood/UCM446580.pdf) 
that changed the blood donor criterion for men who have sex with men 
(MSM) from an indefinite (permanent) deferral to a 12-month deferral 
since last MSM contact. The impact of this change in the deferral 
criteria requires a national monitoring effort as part of TTIMS to 
assess if the relative proportions of risk factors for infection in 
blood donors have changed following the adoption of the 12-month donor 
deferral for MSM. TTIMS will use similar procedures as the ones used in 
the REDS-II study to monitor and evaluate risk factors among HIV-
positive donors and recently HCV or HBV infected donors as well as 
controls.
    This study will help identify the specific risk factors for TTI and 
their prevalence in blood donors, and help inform FDA on the proportion 
of incident (new) infections among all HIV positive blood donors. 
Donations with incident infections have the greatest potential 
transmission risk because they could be missed during routine blood 
screening. The study will help FDA evaluate the effectiveness of 
screening strategies in reducing the risk of HIV transmission from at-
risk donors and to evaluate if there are unexpected consequences 
associated with the recent change in donor deferral policy such as an 
increase in HIV incidence among donors. These data also will inform FDA 
regarding future blood donor deferral policy options to reduce the risk 
of HIV transmission, including the feasibility of moving from the 
existing time-based deferrals related to risk behaviors to alternate 
deferral options, such as the use of individual risk assessments, and 
to inform the design of potential studies to evaluate the feasibility 
and effectiveness of such alternative deferral options.
    TTIMS will include a comprehensive interview based epidemiological 
study of risk factor information for viral infection-positive blood 
donors at the American Red Cross (ARC), Blood Systems, Inc. (BSI), New 
York Blood Center (NYBC), and OneBlood that will identify the current 
predominant risk factors and reasons for virus-positive donations. The 
TTIMS program establishes a new, ongoing donor hemovigilance capacity 
that currently does not exist in the United States. Using procedures 
developed by the REDS-II study, TTIMS will establish this capacity in 
greater than 50 percent of all blood donations collected in the 
country.
    As part of the TTIMS project, a comprehensive hemovigilance 
database will be created that integrates the risk

[[Page 89950]]

factor information collected through donor interviews of blood donor 
with the resulting data from disease marker testing and blood 
components collected by participating organizations into a research 
database. Following successful initiation of the risk factor 
interviews, the TTIMS network is poised to be expanded to include 
additional blood centers and/or re-focused on other safety threats as 
warranted. In this way, the TTIMS program will maintain standardized, 
statistically and scientifically robust processes for applying 
hemovigilance information across blood collection organizations.
    The specific objectives are to:
     Determine current behavioral risk factors associated with 
all HIV infections, incident HBV, and incident HCV infections in blood 
donors (including parenteral and sexual risks) across the participating 
blood collection organizations using a case-control study design.
     Determine infectious disease marker prevalence and 
incidence for HIV, HBV, and HCV overall and by demographic 
characteristics of donors in the majority of blood donations collected 
in the country. This will be accomplished by forming epidemiological 
databases consisting of harmonized operational data from ARC, BSI, 
NYBC, and OneBlood.
     Analyze integrated risk factor and infectious marker 
testing data concurrently because when taken together these may suggest 
that blood centers are not achieving the same degree of success in 
educational efforts to prevent donation by donors with risk behaviors 
across all demographic groups.
    The respondents will be persons who donated blood in the United 
States and these participants will be defined as cases and controls. 
The estimated number of respondents is based on an overall expected 
participation in the risk factor survey. We estimate a case to control 
ratio of 1:2 (200 to 400) with a 50 percent case enrollment.
    In the Federal Register of September 30, 2016 (81 FR 67358), FDA 
published a 60-day notice requesting public comment on the proposed 
collection of information. FDA received a few comments from the public. 
FDA concurs with one comment that providing more information to the 
blood center and FDA may aid in prevention of transmission of 
infectious disease and is critical to the safety of the blood supply. 
Four comments received were not responsive to the comment request on 
the four specified aspects of the collection of information. None of 
the responses specifically commented on any of the proposed questions, 
nor did they request that FDA make any other changes to the Donor Risk 
Assessment Questionnaire. Furthermore, the responses did not provide 
any data or explanation that would support a change regarding the 
information collection requirements.
    FDA estimates the burden of this collection of information as 
follows:

                                 Table 1--Estimated Annual Reporting Burden \1\
----------------------------------------------------------------------------------------------------------------
                                                   Number of
     Questionnaire/survey          Number of     responses per   Total annual    Average burden     Total hours
                                  respondents     respondent       responses      per response
----------------------------------------------------------------------------------------------------------------
Cases and controls \2\........             600               1             600  0.75 (45                     450
                                                                                 minutes).
----------------------------------------------------------------------------------------------------------------
\1\ There are no capital costs or operating and maintenance costs associated with this collection of
  information.
\2\ Cases consist of virus-positive donations, and controls represent uninfected donors.


    Dated: December 8, 2016.
Leslie Kux,
Associate Commissioner for Policy.
[FR Doc. 2016-29814 Filed 12-12-16; 8:45 am]
 BILLING CODE 4164-01-P



                                                                          Federal Register / Vol. 81, No. 239 / Tuesday, December 13, 2016 / Notices                                           89949

                                               fully implement the feed standards will                 collection of information to OMB for                  ComplianceRegulatoryInformation/
                                               vary among States.                                      review and clearance.                                 Guidances/Blood/UCM446580.pdf) that
                                                 Dated: December 8, 2016.                                 Donor Risk Assessment Questionnaire                changed the blood donor criterion for
                                                                                                       for FDA/National Heart, Lung, and                     men who have sex with men (MSM)
                                               Leslie Kux,
                                                                                                       Blood Institute (NHLBI)-sponsored                     from an indefinite (permanent) deferral
                                               Associate Commissioner for Policy.
                                                                                                       Transfusion-Transmissible Infections                  to a 12-month deferral since last MSM
                                               [FR Doc. 2016–29839 Filed 12–12–16; 8:45 am]            Monitoring System (TTIMS)—Risk                        contact. The impact of this change in
                                               BILLING CODE 4164–01–P                                  Factor Elicitation OMB Control                        the deferral criteria requires a national
                                                                                                       Number—New                                            monitoring effort as part of TTIMS to
                                                                                                          FDA intends to interview blood                     assess if the relative proportions of risk
                                               DEPARTMENT OF HEALTH AND                                donors to collect risk factor information             factors for infection in blood donors
                                               HUMAN SERVICES                                          associated with testing positive for a                have changed following the adoption of
                                                                                                       Transfusion-Transmissible Infection                   the 12-month donor deferral for MSM.
                                               Food and Drug Administration
                                                                                                       (TTI). This collection of information is              TTIMS will use similar procedures as
                                               [Docket No. FDA–2016–N–2836]                            part of a larger initiative called TTIMS,             the ones used in the REDS–II study to
                                                                                                       which is a collaborative project funded               monitor and evaluate risk factors among
                                               Agency Information Collection                           by FDA, the NHLBI of the National                     HIV-positive donors and recently HCV
                                               Activities; Submission for Office of                    Institutes of Health (NIH), and the                   or HBV infected donors as well as
                                               Management and Budget Review;                           Department of Health and Human                        controls.
                                               Comment Request; Donor Risk                             Services (HHS) Office of the Assistant                   This study will help identify the
                                               Assessment Questionnaire for the                        Secretary of Health with input from                   specific risk factors for TTI and their
                                               Food and Drug Administration/National                   other Agencies in HHS, including the                  prevalence in blood donors, and help
                                               Heart, Lung, and Blood Institute-                       Centers for Disease Control and                       inform FDA on the proportion of
                                               Sponsored Transfusion-Transmissible                     Prevention (CDC). FDA will use these                  incident (new) infections among all HIV
                                               Infections Monitoring System—Risk                       scientific data collected through such                positive blood donors. Donations with
                                               Factor Elicitation                                      interview-based risk factor elicitation of            incident infections have the greatest
                                               AGENCY:    Food and Drug Administration,                blood donors to monitor and help                      potential transmission risk because they
                                               HHS.                                                    ensure the safety of the U.S. blood                   could be missed during routine blood
                                                                                                       supply.                                               screening. The study will help FDA
                                               ACTION:   Notice.                                          Previous assessments of risk factor                evaluate the effectiveness of screening
                                               SUMMARY:   The Food and Drug                            profiles among blood donors found to be               strategies in reducing the risk of HIV
                                               Administration (FDA) is announcing                      positive for human immunodeficiency                   transmission from at-risk donors and to
                                               that a proposed collection of                           virus (HIV) were funded by CDC for                    evaluate if there are unexpected
                                               information has been submitted to the                   approximately 10 years after                          consequences associated with the recent
                                               Office of Management and Budget                         implementation of HIV serologic                       change in donor deferral policy such as
                                               (OMB) for review and clearance under                    screening of blood donors in the mid-                 an increase in HIV incidence among
                                               the Paperwork Reduction Act of 1995.                    1980s; whereas studies of Hepatitis C                 donors. These data also will inform FDA
                                               DATES: Fax written comments on the
                                                                                                       virus (HCV) seropositive donors, funded               regarding future blood donor deferral
                                               collection of information by January 12,                by NIH, were conducted in the early                   policy options to reduce the risk of HIV
                                               2017.                                                   1990s. Information on current risk                    transmission, including the feasibility of
                                                                                                       factors in blood donors as assessed                   moving from the existing time-based
                                               ADDRESSES: To ensure that comments on
                                                                                                       using analytical study designs was next               deferrals related to risk behaviors to
                                               the information collection are received,                evaluated by the Transfusion-                         alternate deferral options, such as the
                                               OMB recommends that written                             Transmitted Retrovirus and Hepatitis                  use of individual risk assessments, and
                                               comments be faxed to the Office of                      Virus Rates and Risk Factors Study                    to inform the design of potential studies
                                               Information and Regulatory Affairs,                     conducted by the NHLBI Retrovirus                     to evaluate the feasibility and
                                               OMB, Attn: FDA Desk Officer, FAX:                       Epidemiology Donor Study-II (REDS–II)                 effectiveness of such alternative deferral
                                               202–395–7285, or emailed to oira_                       approved under OMB control number                     options.
                                               submission@omb.eop.gov. All                             0925–0630. Through a risk factor                         TTIMS will include a comprehensive
                                               comments should be identified with the                  questionnaire, this study elicited risk               interview based epidemiological study
                                               OMB control number 0910—New and                         factors in blood donors who tested                    of risk factor information for viral
                                               title ‘‘Donor Risk Assessment                           confirmed positive for one of four                    infection-positive blood donors at the
                                               Questionnaire for the Food and Drug                     transfusion-transmissible infections:                 American Red Cross (ARC), Blood
                                               Administration/National Heart, Lung,                    HIV, HCV, Hepatitis B virus (HBV), and                Systems, Inc. (BSI), New York Blood
                                               and Blood Institute-sponsored                           Human T-cell Lymphotropic virus. The                  Center (NYBC), and OneBlood that will
                                               Transfusion-Transmissible Infections                    study also elicited risk factors from                 identify the current predominant risk
                                               Monitoring System—Risk Factor                           donors who did not have any infections                factors and reasons for virus-positive
                                               Elicitation.’’ Also include the FDA                     (controls) and compared their responses               donations. The TTIMS program
                                               docket number found in brackets in the                  to those of the donors with confirmed                 establishes a new, ongoing donor
                                               heading of this document.                               infection (cases). Results from the                   hemovigilance capacity that currently
                                               FOR FURTHER INFORMATION CONTACT: FDA                    REDS–II study were published in 2015.                 does not exist in the United States.
pmangrum on DSK3GDR082PROD with NOTICES




                                               PRA Staff, Office of Operations, Food                      FDA issued a document entitled                     Using procedures developed by the
                                               and Drug Administration, Three White                    ‘‘Revised Recommendations for                         REDS–II study, TTIMS will establish
                                               Flint North, 10A63, 11601 Landsdown                     Reducing the Risk of Human                            this capacity in greater than 50 percent
                                               St., North Bethesda, MD 20852,                          Immunodeficiency Virus Transmission                   of all blood donations collected in the
                                               PRAStaff@fda.hhs.gov.                                   by Blood and Blood Products, Guidance                 country.
                                               SUPPLEMENTARY INFORMATION: In                           for Industry’’ dated December 2015                       As part of the TTIMS project, a
                                               compliance with 44 U.S.C. 3507, FDA                     (http://www.fda.gov/downloads/                        comprehensive hemovigilance database
                                               has submitted the following proposed                    BiologicsBloodVaccines/Guidance                       will be created that integrates the risk


                                          VerDate Sep<11>2014   15:08 Dec 12, 2016   Jkt 241001   PO 00000   Frm 00058   Fmt 4703   Sfmt 4703   E:\FR\FM\13DEN1.SGM   13DEN1


                                               89950                         Federal Register / Vol. 81, No. 239 / Tuesday, December 13, 2016 / Notices

                                               factor information collected through                      HIV, HBV, and HCV overall and by                           In the Federal Register of September
                                               donor interviews of blood donor with                      demographic characteristics of donors                   30, 2016 (81 FR 67358), FDA published
                                               the resulting data from disease marker                    in the majority of blood donations                      a 60-day notice requesting public
                                               testing and blood components collected                    collected in the country. This will be                  comment on the proposed collection of
                                               by participating organizations into a                     accomplished by forming                                 information. FDA received a few
                                               research database. Following successful                   epidemiological databases consisting of                 comments from the public. FDA concurs
                                               initiation of the risk factor interviews,                 harmonized operational data from ARC,                   with one comment that providing more
                                               the TTIMS network is poised to be                         BSI, NYBC, and OneBlood.                                information to the blood center and
                                               expanded to include additional blood                         • Analyze integrated risk factor and                 FDA may aid in prevention of
                                               centers and/or re-focused on other                        infectious marker testing data                          transmission of infectious disease and is
                                               safety threats as warranted. In this way,                 concurrently because when taken                         critical to the safety of the blood supply.
                                               the TTIMS program will maintain                           together these may suggest that blood                   Four comments received were not
                                               standardized, statistically and                           centers are not achieving the same                      responsive to the comment request on
                                               scientifically robust processes for                       degree of success in educational efforts                the four specified aspects of the
                                               applying hemovigilance information                        to prevent donation by donors with risk                 collection of information. None of the
                                               across blood collection organizations.                    behaviors across all demographic                        responses specifically commented on
                                                  The specific objectives are to:                                                                                any of the proposed questions, nor did
                                                  • Determine current behavioral risk                    groups.
                                                                                                            The respondents will be persons who                  they request that FDA make any other
                                               factors associated with all HIV
                                                                                                         donated blood in the United States and                  changes to the Donor Risk Assessment
                                               infections, incident HBV, and incident
                                                                                                         these participants will be defined as                   Questionnaire. Furthermore, the
                                               HCV infections in blood donors
                                                                                                         cases and controls. The estimated                       responses did not provide any data or
                                               (including parenteral and sexual risks)
                                               across the participating blood collection                 number of respondents is based on an                    explanation that would support a
                                               organizations using a case-control study                  overall expected participation in the                   change regarding the information
                                               design.                                                   risk factor survey. We estimate a case to               collection requirements.
                                                  • Determine infectious disease                         control ratio of 1:2 (200 to 400) with a                   FDA estimates the burden of this
                                               marker prevalence and incidence for                       50 percent case enrollment.                             collection of information as follows:

                                                                                                TABLE 1—ESTIMATED ANNUAL REPORTING BURDEN 1
                                                                                                                    Number of
                                                                                                 Number of                             Total annual
                                                        Questionnaire/survey                                      responses per                             Average burden per response                   Total hours
                                                                                                respondents                             responses
                                                                                                                    respondent

                                               Cases and controls 2 .........................             600                    1                600   0.75 (45 minutes) .............................            450
                                                  1 Thereare no capital costs or operating and maintenance costs associated with this collection of information.
                                                  2 Cases consist of virus-positive donations, and controls represent uninfected donors.




                                                 Dated: December 8, 2016.                                registration and product listing                        comments, that information will be
                                               Leslie Kux,                                               submissions to FDA.                                     posted on http://www.regulations.gov.
                                               Associate Commissioner for Policy.                        DATES: Submit either electronic or                        • If you want to submit a comment
                                               [FR Doc. 2016–29814 Filed 12–12–16; 8:45 am]              written comments on Agency guidances                    with confidential information that you
                                               BILLING CODE 4164–01–P                                    at any time.                                            do not wish to be made available to the
                                                                                                                                                                 public, submit the comment as a
                                                                                                         ADDRESSES: You may submit comments
                                                                                                                                                                 written/paper submission and in the
                                                                                                         as follows:                                             manner detailed (see ‘‘Written/Paper
                                               DEPARTMENT OF HEALTH AND
                                               HUMAN SERVICES                                            Electronic Submissions                                  Submissions’’ and ‘‘Instructions’’).
                                                                                                           Submit electronic comments in the                     Written/Paper Submissions
                                               Food and Drug Administration
                                                                                                         following way:                                             Submit written/paper submissions as
                                               [Docket No. FDA–2009–D–0508]                                • Federal eRulemaking Portal: http://                 follows:
                                                                                                         www.regulations.gov. Follow the                            • Mail/Hand delivery/Courier (for
                                               Registration and Product Listing for                      instructions for submitting comments.                   written/paper submissions): Division of
                                               Owners and Operators of Domestic                          Comments submitted electronically,                      Dockets Management (HFA–305), Food
                                               Tobacco Product Establishment;                            including attachments, to http://                       and Drug Administration, 5630 Fishers
                                               Guidance for Industry; Availability                       www.regulations.gov will be posted to                   Lane, Rm. 1061, Rockville, MD 20852.
                                               AGENCY:      Food and Drug Administration,                the docket unchanged. Because your                         • For written/paper comments
                                               HHS.                                                      comment will be made public, you are                    submitted to the Division of Dockets
                                               ACTION:    Notice of availability.                        solely responsible for ensuring that your               Management, FDA will post your
                                                                                                         comment does not include any                            comment, as well as any attachments,
                                               SUMMARY:   The Food and Drug                              confidential information that you or a                  except for information submitted,
pmangrum on DSK3GDR082PROD with NOTICES




                                               Administration (FDA) is announcing the                    third party may not wish to be posted,                  marked and identified, as confidential,
                                               availability of a revised guidance for                    such as medical information, your or                    if submitted as detailed in
                                               industry entitled ‘‘Registration and                      anyone else’s Social Security number, or                ‘‘Instructions.’’
                                               Product Listing for Owners and                            confidential business information, such                    Instructions: All submissions received
                                               Operators of Domestic Tobacco Product                     as a manufacturing process. Please note                 must include the Docket No. FDA–
                                               Establishments.’’ This guidance is                        that if you include your name, contact                  2009–D–0508 for ‘‘Registration and
                                               intended to assist persons making                         information, or other information that                  Product Listing for Owners and
                                               tobacco product establishment                             identifies you in the body of your                      Operators of Domestic Tobacco Product


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Document Created: 2016-12-13 02:44:02
Document Modified: 2016-12-13 02:44:02
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionNotice.
DatesFax written comments on the collection of information by January 12, 2017.
ContactFDA PRA Staff, Office of Operations, Food and Drug Administration, Three White Flint North, 10A63, 11601 Landsdown St., North Bethesda, MD 20852, [email protected]
FR Citation81 FR 89949 

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