Agency Information Collection Activities: Submission for OMB Review; Comment Request, 28851-28852 [2017-13321]
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Federal Register / Vol. 82, No. 121 / Monday, June 26, 2017 / Notices
cost to respondents other than the time
to participate in information collection.
The total estimated burden for all of
the information collections is not
expected to exceed 1,500 hours (100
hours of burden for a maximum of 15
potentially PRA-applicable contracts).
ESTIMATED ANNUALIZED BURDEN HOURS
Number of
responses per
respondent
Number of
respondents
Average
burden per
response
(in hrs.)
Total burden
(in hrs.)
Type of respondents
Form name
Public ................................................
Information Collection .......................
150
1
1
1,500
Total ...........................................
...........................................................
........................
........................
........................
1,500
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. 2017–13320 Filed 6–23–17; 8:45 am]
BILLING CODE 4163–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–1561/1561A,
CMS–370 and CMS–377]
Agency Information Collection
Activities: Submission for OMB
Review; Comment Request
Centers for Medicare &
Medicaid Services, HHS.
ACTION: Notice.
AGENCY:
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 the necessity and
utility of the proposed information
collection for the proper performance of
the agency’s functions, the accuracy of
the estimated burden, ways to enhance
the quality, utility, and clarity of the
information to be collected; and the use
of automated collection techniques or
other forms of information technology to
minimize the information collection
burden.
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SUMMARY:
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Comments on the collection(s) of
information must be received by the
OMB desk officer by July 26, 2017.
ADDRESSES: When commenting on the
proposed information collections,
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:
OIRA_submission@omb.eop.gov.
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
Web site address at https://
www.cms.gov/Regulations-andGuidance/Legislation/
PaperworkReductionActof1995/PRAListing.html.
2. Email your request, including your
address, phone number, OMB number,
and CMS document identifier, to
Paperwork@cms.hhs.gov.
3. Call the Reports Clearance Office at
(410) 786–1326.
FOR FURTHER INFORMATION CONTACT:
William Parham at (410) 786–4669.
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,
DATES:
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Sfmt 4703
revision 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: Extension of a currently
approved collection; Title of
Information Collection: Health
Insurance Benefit Agreement; Use:
Applicants to the Medicare program are
required to agree to provide services in
accordance with federal requirements.
The CMS–1561/1561A is essential in
that is allows us to ensure that
applicants are in compliance with the
requirements. Applicants will be
required to sign the completed form and
provide operational information to us to
assure that they continue to meet the
requirements after approval. Form
Number: CMS–1561/1561A (OMB
control number: 0938–0832); Frequency:
Yearly; Affected Public: Private sector—
(Business or other for-profits and Notfor-profit institutions); Number of
Respondents: 2,400; Total Annual
Responses: 2,400; Total Annual Hours:
400. (For policy questions regarding this
collection contact Shonte Carter at 410–
786–3532).
2. Type of Information Collection
Request: Extension of a currently
approved collection; Titles of
Information Collection: ASC Forms for
Medicare Program Certification; Use:
The CMS–370 is used to establish
eligibility for payment. This agreement,
upon submission by the ambulatory
surgical center (ASC) and acceptance for
filing by the Secretary of Health &
Human Services, shall be binding on
both the ASC and the Secretary. The
agreement may be terminated by either
party in accordance with regulations. In
the event of termination, payment will
not be available for ASC services
furnished on or after the effective date
of termination.
The Request for Certification or
Update of Certification Information in
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Federal Register / Vol. 82, No. 121 / Monday, June 26, 2017 / Notices
the Medicare Program Form (CMS–377)
is used by State agencies who conduct
certification surveys on CMS’ behalf to
maintain information on the facility’s
characteristics that facilitate conducting
surveys, e.g., determining the size and
the composition of the survey team on
the basis of the number of ORs/
procedure rooms and the types of
surgical procedures performed in the
ASC. Form Numbers: CMS–370 and
CMS–377 (OMB control number: 0938–
0266); Frequency: Occasionally;
Affected Public: Private Sector—
Business or other for-profit and Not-forprofit institutions; Number of
Respondents: 5,694; Total Annual
Responses: 1,898; Total Annual Hours:
627. (For policy questions regarding this
collection contact Erin McCoy at 410–
786–2337.)
Dated: June 21, 2017.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office
of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2017–13321 Filed 6–23–17; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–10292, CMS–
10332 and CMS–10239]
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Centers for Medicare &
Medicaid Services, HHS.
ACTION: Notice.
AGENCY:
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 (the
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
60 days for public comment on the
proposed action. Interested persons are
invited to send comments regarding our
burden estimates or any other aspect of
this collection of information, including
the necessity and utility of the proposed
information collection for the proper
performance of the agency’s functions,
the accuracy of the estimated burden,
ways to enhance the quality, utility, and
clarity of the information to be
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SUMMARY:
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17:04 Jun 23, 2017
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collected, and the use of automated
collection techniques or other forms of
information technology to minimize the
information collection burden.
DATES: Comments must be received by
August 25, 2017.
ADDRESSES: When commenting, please
reference the document identifier or
OMB control number. To be assured
consideration, comments and
recommendations must be submitted in
any one of the following ways:
1. Electronically. You may send your
comments electronically to https://
www.regulations.gov. Follow the
instructions for ‘‘Comment or
Submission’’ or ‘‘More Search Options’’
to find the information collection
document(s) that are accepting
comments.
2. By regular mail. You may mail
written comments to the following
address: CMS, Office of Strategic
Operations and Regulatory Affairs,
Division of Regulations Development,
Attention: Document Identifier/OMB
Control Number _________, Room C4–
26–05, 7500 Security Boulevard,
Baltimore, Maryland 21244–1850.
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
https://www.cms.gov/Regulations-andGuidance/Legislation/
PaperworkReductionActof1995/PRAListing.html.
2. Email your request, including your
address, phone number, OMB number,
and CMS document identifier, to
Paperwork@cms.hhs.gov.
3. Call the Reports Clearance Office at
(410) 786–1326.
FOR FURTHER INFORMATION CONTACT:
William Parham at (410) 786–4669.
SUPPLEMENTARY INFORMATION:
Contents
This notice sets out a summary of the
use and burden associated with the
following information collections. More
detailed information can be found in
each collection’s supporting statement
and associated materials (see
ADDRESSES).
CMS–10292 State Medicaid HIT Plan,
Planning Advance Planning Document,
and Implementation Advance Planning
Document for Section 4201 of the Recovery
Act
CMS–10332 Disclosure Requirement for the
In-Office Ancillary Services Exception
CMS–10239 Conditions of Participation for
Critical Access Hospitals (CAH) and
Supporting Regulations
Under the PRA (44 U.S.C. 3501–
3520), federal agencies must obtain
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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
requires federal agencies to publish a
60-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.
Information Collection
1. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: State Medicaid
HIT Plan, Planning Advance Planning
Document, and Implementation
Advance Planning Document for
Section 4201 of the Recovery Act; Use:
To assess the appropriateness of state
requests for the administrative Federal
financial participation for expenditures
under their Medicaid Electronic Health
Record Incentive Program related to
health information exchange, our staff
will review the submitted information
and documentation to make an approval
determination of the state advance
planning document. Form Number:
CMS–10292 (OMB control number:
0938–1088); Frequency: Once and
occasionally; Affected Public: State,
Local, and Tribal Governments; Number
of Respondents: 56; Total Annual
Responses: 56; Total Annual Hours:
896. (For policy questions regarding this
collection contact Marty Rice at 410–
786–2417.)
2. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Disclosure
Requirement for the In-Office Ancillary
Services Exception; Use: Section 6003 of
the ACA established a disclosure
requirement for the in-office ancillary
services exception to the prohibition of
physician self-referral for certain
imaging services. This section of the
ACA amended section 1877(b)(2) of the
Social Security Act by adding a
requirement that the referring physician
informs the patient, at the time of the
referral and in writing, that the patient
may receive the imaging service from
another supplier. The implementing
regulations are at 42 CFR 411.355(b)(7).
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Agencies
[Federal Register Volume 82, Number 121 (Monday, June 26, 2017)]
[Notices]
[Pages 28851-28852]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-13321]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-1561/1561A, CMS-370 and CMS-377]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
AGENCY: Centers for Medicare & Medicaid Services, HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: 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 the necessity and utility of the
proposed information collection for the proper performance of the
agency's functions, the accuracy of the estimated burden, ways to
enhance the quality, utility, and clarity of the information to be
collected; and 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 July 26, 2017.
ADDRESSES: When commenting on the proposed information collections,
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:
OIRA_submission@omb.eop.gov.
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 Web site address at https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html.
2. Email your request, including your address, phone number, OMB
number, and CMS document identifier, to Paperwork@cms.hhs.gov.
3. Call the Reports Clearance Office at (410) 786-1326.
FOR FURTHER INFORMATION CONTACT: William Parham at (410) 786-4669.
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, revision 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: Extension of a currently
approved collection; Title of Information Collection: Health Insurance
Benefit Agreement; Use: Applicants to the Medicare program are required
to agree to provide services in accordance with federal requirements.
The CMS-1561/1561A is essential in that is allows us to ensure that
applicants are in compliance with the requirements. Applicants will be
required to sign the completed form and provide operational information
to us to assure that they continue to meet the requirements after
approval. Form Number: CMS-1561/1561A (OMB control number: 0938-0832);
Frequency: Yearly; Affected Public: Private sector--(Business or other
for-profits and Not-for-profit institutions); Number of Respondents:
2,400; Total Annual Responses: 2,400; Total Annual Hours: 400. (For
policy questions regarding this collection contact Shonte Carter at
410-786-3532).
2. Type of Information Collection Request: Extension of a currently
approved collection; Titles of Information Collection: ASC Forms for
Medicare Program Certification; Use: The CMS-370 is used to establish
eligibility for payment. This agreement, upon submission by the
ambulatory surgical center (ASC) and acceptance for filing by the
Secretary of Health & Human Services, shall be binding on both the ASC
and the Secretary. The agreement may be terminated by either party in
accordance with regulations. In the event of termination, payment will
not be available for ASC services furnished on or after the effective
date of termination.
The Request for Certification or Update of Certification
Information in
[[Page 28852]]
the Medicare Program Form (CMS-377) is used by State agencies who
conduct certification surveys on CMS' behalf to maintain information on
the facility's characteristics that facilitate conducting surveys,
e.g., determining the size and the composition of the survey team on
the basis of the number of ORs/procedure rooms and the types of
surgical procedures performed in the ASC. Form Numbers: CMS-370 and
CMS-377 (OMB control number: 0938-0266); Frequency: Occasionally;
Affected Public: Private Sector--Business or other for-profit and Not-
for-profit institutions; Number of Respondents: 5,694; Total Annual
Responses: 1,898; Total Annual Hours: 627. (For policy questions
regarding this collection contact Erin McCoy at 410-786-2337.)
Dated: June 21, 2017.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2017-13321 Filed 6-23-17; 8:45 am]
BILLING CODE 4120-01-P