Agency Information Collection Activities: Proposed Collection; Comment Request, 3531-3532 [05-1320]
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Federal Register / Vol. 70, No. 15 / Tuesday, January 25, 2005 / Notices
regulations/pra/, or E-mail your request,
including your address, phone number,
OMB number, and CMS document
identifier, to Paperwork@cms.hhs.gov,
or call the Reports Clearance Office on
(410) 768–1326.
Written comments and
recommendations for the proposed
information collection must be mailed
within 30 days of this notice directly to
the OMB desk officer: OMB Human
Resources and Housing Branch,
Attention: Christopher Martin, New
Executive Office Building, Room 10235,
Washington, DC 20503.
Dated: January 13, 2005.
Dawn Willingham,
Acting, CMS Paperwork Reduction Act
Reports Clearance Officer, Office of Strategic
Operations and Regulatory Affairs,
Regulations Development Group.
[FR Doc. 05–1319 Filed 1–24–05; 8:45 am]
BILLING CODE 4120–03–M
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–8003, CMS–
10060, CMS–287, CMS–R–245, CMS–21/
CMS–21B, CMS–64, and CMS–R–209]
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Centers for Medicare &
Medicaid Services, HHS.
In compliance with the requirement
of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the
Centers for Medicare & Medicaid
Services (CMS) is publishing the
following summary of proposed
collections 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.
1. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Home and
Community-Based Waiver Requests and
Supporting Regulations in 42 CFR
AGENCY:
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13:14 Jan 24, 2005
Jkt 205001
440.180 and 441.300–.310; Use: Under a
Secretarial waiver, States may offer a
wide array of home and communitybased services to individuals who
would otherwise require
institutionalization. States requesting a
waiver must provide certain assurances,
documentation and cost & utilization
estimates which are reviewed, approved
and maintained for the purpose of
identifying/verifying States’ compliance
with such statutory and regulatory
requirements; Form Number: CMS–8003
(OMB#: 0938–0449); Frequency: Other:
When a State requests a waiver or
amendment to a waiver; Affected Public:
State, Local or Tribal Government;
Number of Respondents: 50; Total
Annual Responses: 132; Total Annual
Hours: 7,930.
2. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Quality
Assessment and Performance
Improvement (QAPI) Project
Completion Report and Supporting
Regulations in 42 CFR 422.152; Use:
This project completion report derives
from the Quality Improvement System
for Managed Care (QISMC) Standards
and Guidelines as required by the
Balanced Budget Act of 1997 (as
amended by Balanced Budget
Refinement Act of 1999) and the related
regulations, 42 CFR 422.152. These
regulations established QISMC as a
requirement for Medicare+Choice (M+C)
Organizations by requiring improved
health outcomes for enrolled
beneficiaries. The provisions of QISMC
specify that M+C organizations will
implement and evaluate quality
improvement projects. The form
submitted herein will permit M+C
organizations to report their completed
projects to CMS in a standardized
fashion for evaluation by CMS of the
M+C Organization’s compliance with
regulatory provisions. This form will
improve consistency and reliability in
the CMS evaluation process, as well as
provide a standardized structure for
public use and review; Form Number:
CMS–10060 (OMB#: 0938–0873);
Frequency: Annually; Affected Public:
Business or other for-profit and Not-forprofit institutions; Number of
Respondents: 155; Total Annual
Responses: 155; Total Annual Hours:
620.
3. Type of Information Request:
Revision of a currently approved
collection; Title of Information
Collection: Home Office Cost Statement
and Supporting Regulations in 42 CFR
413.17 and 413.20; Use: Home Office
Cost Statement, is filed annually by
Chain Home Offices to report the
PO 00000
Frm 00025
Fmt 4703
Sfmt 4703
3531
information necessary for the
determination of Medicare
reimbursement to components of chain
organizations. Many providers of service
participating in Medicare are
reimbursed, at least partially, on the
basis of the lesser of reasonable cost or
customary services for services
furnished to eligible beneficiaries. When
providers obtain services, supplies or
facilities from an organization related to
the provider by common ownership or
control, 42 CFR 413.17 requires that the
provider include in its costs, the costs
incurred by the related organization in
furnishing such services, supplies or
facilities. Revisions to this form include
the addition of columns for more
detailed reporting and the elimination
of other columns that were deemed
unnecessary; Form Number: CMB–287
(OMB# 0938–0202); Frequency:
Annually; Affected Public: Not-for-profit
institutions and Business or other forprofit; Number of Respondents: 1,231;
Total Annual Responses: 1,231; Total
Annual Hours: 573,646.
4. Type of Information Request:
Extension of a currently approved
collection; Title of Information
Collection: Medicare and Medicaid
Programs; OASIS Collection
Requirements as Part of the COPs for
HHAs and Supporting Regulations in 42
CFR, Sections 484.55, 484.205, 484.245,
and 484.250; Use: This collection
requires HHAs to use a standard core
assessment data set, the OASIS, to
collect information and to evaluate
adult non-maternity patients. In
addition, data from the OASIS will be
used for purposes of case-mix adjusting
patients under home health PPS, and
will facilitate the production of
necessary case-mix information at
relevant time intervals in the patient’s
home health stay. Modifications were
previously made to the OASIS forms to
allow for the preservation of masking of
personally identifiable information for
the non-Medicare/non-Medicaid
individuals; Form Number: CMS–R–245
(OMB# 0938–0760); Frequency: Other:
Upon patient assessment; Affected
Public: Business or other for-profit, Notfor-profit institutions, Federal
Government, and State, Local or Tribal
Gov.; Number of Respondents: 7,582;
Total Annual Responses: 10,156,569;
Total Annual Hours: 8,556,995.
5. Type of Information Request:
Extension of a currently approved
collection; Title of Information
Collection: Quarterly Children’s Health
Insurance Program (CHIP) Statement of
Expenditures for Title XXI; Use: States
use forms CMS–21 and CMS–21B to
report budget, expenditure, and related
statistical information required for
E:\FR\FM\25JAN1.SGM
25JAN1
3532
Federal Register / Vol. 70, No. 15 / Tuesday, January 25, 2005 / Notices
implementation of the Children’s Health
Insurance Program. The information
provided by these forms is used by CMS
to prepare the grant awards to States for
the Medicaid and CHIP programs, to
ensure that the appropriate level of
Federal payments for State expenditures
under the Medicaid program and CHIP
are made in accordance with the CHIP
related Balanced Budget Act legislation
provisions, and to track, monitor, and
evaluate the numbers of related children
being served by the Medicaid and CHIP
programs; Form Number: CMS–21 and
CMS–21B (OMB# 0938–0731);
Frequency: Quarterly; Affected Public:
State, Local or Tribal Gov.; Number of
Respondents: 56; Total Annual
Responses: 448; Total Annual Hours:
7,840.
6. Type of Information Request:
Revision of a currently approved
collection; Title of Information
Collection: Quarterly Medicaid
Statement of Expenditures for the
Medical Assistance Program; Use: The
State Medicaid agencies use the form
CMS–64 for the Medical Assistance
Program to report their actual program
benefit costs and administrative
expenses to CMS. CMS uses this
information to compute the Federal
financial participation for the State’s
Medicaid Program costs. The structure
of the current from CMS–64 has evolved
from the previous forms used for
reporting and has been revised.
Classification, identification, and
referencing used in the CMS–64 forms
has been in place for several years, is
readily understood and accepted by the
report users, and is supported by strong
sentiments in both CMS and the States
to maintain the existing format.
Therefore, our modifications have been
made to maintain the current reporting
format by incorporating all changes into
the existing report structure; Form
Number: CMS–64 (OMB# 0938–0067);
Frequency: Quarterly; Affected Public:
State, Local or Tribal Gov.; Number of
Respondents: 56; Total Annual
Responses: 224; Total Annual Hours:
16,464.
7. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Medicare and
Medicaid Programs; Use and Reporting
OASIS Data as Part of the CoPs for
HHAs and Supporting Regulations in 42
CFR 484.11 and 484.20; Form No.:
CMS–R–209 (OMB# 0938–0761); Use:
HHAs are required to report data from
the OASIS as a condition of
participation. Specifically, the above
named regulation sections provide
guidelines for HHAs for the electronic
transmission of the OASIS data as well
VerDate jul<14>2003
13:14 Jan 24, 2005
Jkt 205001
as responsibilities of the State agency or
OASIS contractor in collecting and
transmitting this information to CMS.
These requirements are necessary to
achieve broad-based, measurable
improvement, in the quality of care
furnished through Federal programs,
and to establish a prospective payment
system for HHAs; Frequency: Monthly;
Affected Public: Business or other-forprofit, Federal Government, State, Local
or Tribal Government, Not-for-profit
institutions; Number of Respondents:
7,582; Total Annual Responses: 93,621;
Total Annual Hours: 921,271.
To obtain copies of the supporting
statement and any related forms for the
proposed paperwork collections
referenced above, access CMS’ Web site
address at https://www.cms.hhs.gov/
regulations/pra/, or E-mail your request,
including your address, phone number,
OMB number, and CMS document
identifier, to Paperwork@cms.hhs.gov,
or call the Reports Clearance Office on
(410) 786–1326.
Written comments and
recommendations for the proposed
information collections must be mailed
within 60 days of this notice directly to
the CMS Paperwork Reduction Act
Reports Clearance Officer designated at
the address below: CMS, Office of
Strategic Operations and Regulatory
Affairs, Division of Regulations
Development, Attention: Melissa
Musotto, Room C5–14–03, 7500
Security Boulevard, Baltimore,
Maryland 21244–1850.
Dated: January 13, 2005.
Dawn Willinghan,
Acting, CMS Paperwork Reduction Act
Reports Clearance Officer, Office of Strategic
Operations and Regulatory Affairs,
Regulations Development Group.
[FR Doc. 05–1320 Filed 1–24–05; 8:45 am]
BILLING CODE 4120–03–M
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Proposed Information Collection
Activity; Comment Request
Proposed Projects
Title: Employment Retention and
Advancement (ERA) Evaluation 42Month Survey.
OMB No.: New Collection.
Description: The Employment
Retention and Advancement (ERA)
Evaluation is sponsored by the
Administration for Children and
Families (ACF) of the U.S. Department
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Frm 00026
Fmt 4703
Sfmt 4703
of Health and Human Services (HHS),1
and involves the conduct of a multi-year
evaluation that studies the net impact
and cost-benefits of programs designed
to help Temporary Assistance for Needy
Families (TANF) recipients, former
TANF recipients or families at risk of
needing TANF benefits retain and
advance in employment.2 The ERA
Evaluation involves 15 random
assignment experiments in eight states,
testing a diverse set of strategies
designed to promote stable employment
and/or career advancement for lowincome people. The ERA Evaluation
will generate rigorous data on the
implementation, effects and costs of
these alternative approaches. The data
collected as part of the 42-month survey
will be used for the following purposes:
• To study ERA’s long-term impacts
on employment, earnings, participation,
educational attainment and income;
• To gather data on a wider range of
outcome measures than is available
through welfare or Unemployment
Insurance records in order to
understand how individuals were
affected by ERA; participation in
employment and education activities;
educational attainment; employment
history; marriage, household
composition and child care; housing;
household income; household food
insecurity; health coverage and status;
and child outcomes;
• To build upon data collected as part
of the earlier 12-month survey wave;
• To conduct non-experimental
analyses, in addition to experimental
analyses, and provide a descriptive
picture of the circumstances of lowwage workers; and
• To obtain participation information
important to the evaluation’s costbenefits component.
Respondents: The respondents of the
42-month survey are Temporary
Assistance for Needy Families (TANF)
applicants, current and former TANF
recipients or individuals in families at
risk of needing TANF benefits (working
poor and hard-to-employ) who are in
the research sample in a subset of the 15
programs participating in the ERA
Evaluation. Survey participants will be
administered a telephone survey
approximately 42 months after the date
they were enrolled in the research
sample and randomly assigned to the
treatment or control group. For those
individuals who cannot be reached by
phone, survey firm staff will attempt to
contact them in person. A total of
1 The U.S. Department of Labor has also provided
funding to support the ERA project.
2 From the Department of Health and Human
Services RFP No.: 105–99–8100.
E:\FR\FM\25JAN1.SGM
25JAN1
]]>Agencies
[Federal Register Volume 70, Number 15 (Tuesday, January 25, 2005)]
[Notices]
[Pages 3531-3532]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-1320]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-8003, CMS-10060, CMS-287, CMS-R-245, CMS-21/
CMS-21B, CMS-64, and CMS-R-209]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare & Medicaid Services, HHS.
In compliance with the requirement of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the Centers for Medicare & Medicaid
Services (CMS) is publishing the following summary of proposed
collections 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.
1. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Home and
Community-Based Waiver Requests and Supporting Regulations in 42 CFR
440.180 and 441.300-.310; Use: Under a Secretarial waiver, States may
offer a wide array of home and community-based services to individuals
who would otherwise require institutionalization. States requesting a
waiver must provide certain assurances, documentation and cost &
utilization estimates which are reviewed, approved and maintained for
the purpose of identifying/verifying States' compliance with such
statutory and regulatory requirements; Form Number: CMS-8003
(OMB: 0938-0449); Frequency: Other: When a State requests a
waiver or amendment to a waiver; Affected Public: State, Local or
Tribal Government; Number of Respondents: 50; Total Annual Responses:
132; Total Annual Hours: 7,930.
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Quality
Assessment and Performance Improvement (QAPI) Project Completion Report
and Supporting Regulations in 42 CFR 422.152; Use: This project
completion report derives from the Quality Improvement System for
Managed Care (QISMC) Standards and Guidelines as required by the
Balanced Budget Act of 1997 (as amended by Balanced Budget Refinement
Act of 1999) and the related regulations, 42 CFR 422.152. These
regulations established QISMC as a requirement for Medicare+Choice
(M+C) Organizations by requiring improved health outcomes for enrolled
beneficiaries. The provisions of QISMC specify that M+C organizations
will implement and evaluate quality improvement projects. The form
submitted herein will permit M+C organizations to report their
completed projects to CMS in a standardized fashion for evaluation by
CMS of the M+C Organization's compliance with regulatory provisions.
This form will improve consistency and reliability in the CMS
evaluation process, as well as provide a standardized structure for
public use and review; Form Number: CMS-10060 (OMB: 0938-
0873); Frequency: Annually; Affected Public: Business or other for-
profit and Not-for-profit institutions; Number of Respondents: 155;
Total Annual Responses: 155; Total Annual Hours: 620.
3. Type of Information Request: Revision of a currently approved
collection; Title of Information Collection: Home Office Cost Statement
and Supporting Regulations in 42 CFR 413.17 and 413.20; Use: Home
Office Cost Statement, is filed annually by Chain Home Offices to
report the information necessary for the determination of Medicare
reimbursement to components of chain organizations. Many providers of
service participating in Medicare are reimbursed, at least partially,
on the basis of the lesser of reasonable cost or customary services for
services furnished to eligible beneficiaries. When providers obtain
services, supplies or facilities from an organization related to the
provider by common ownership or control, 42 CFR 413.17 requires that
the provider include in its costs, the costs incurred by the related
organization in furnishing such services, supplies or facilities.
Revisions to this form include the addition of columns for more
detailed reporting and the elimination of other columns that were
deemed unnecessary; Form Number: CMB-287 (OMB 0938-0202);
Frequency: Annually; Affected Public: Not-for-profit institutions and
Business or other for-profit; Number of Respondents: 1,231; Total
Annual Responses: 1,231; Total Annual Hours: 573,646.
4. Type of Information Request: Extension of a currently approved
collection; Title of Information Collection: Medicare and Medicaid
Programs; OASIS Collection Requirements as Part of the COPs for HHAs
and Supporting Regulations in 42 CFR, Sections 484.55, 484.205,
484.245, and 484.250; Use: This collection requires HHAs to use a
standard core assessment data set, the OASIS, to collect information
and to evaluate adult non-maternity patients. In addition, data from
the OASIS will be used for purposes of case-mix adjusting patients
under home health PPS, and will facilitate the production of necessary
case-mix information at relevant time intervals in the patient's home
health stay. Modifications were previously made to the OASIS forms to
allow for the preservation of masking of personally identifiable
information for the non-Medicare/non-Medicaid individuals; Form Number:
CMS-R-245 (OMB 0938-0760); Frequency: Other: Upon patient
assessment; Affected Public: Business or other for-profit, Not-for-
profit institutions, Federal Government, and State, Local or Tribal
Gov.; Number of Respondents: 7,582; Total Annual Responses: 10,156,569;
Total Annual Hours: 8,556,995.
5. Type of Information Request: Extension of a currently approved
collection; Title of Information Collection: Quarterly Children's
Health Insurance Program (CHIP) Statement of Expenditures for Title
XXI; Use: States use forms CMS-21 and CMS-21B to report budget,
expenditure, and related statistical information required for
[[Page 3532]]
implementation of the Children's Health Insurance Program. The
information provided by these forms is used by CMS to prepare the grant
awards to States for the Medicaid and CHIP programs, to ensure that the
appropriate level of Federal payments for State expenditures under the
Medicaid program and CHIP are made in accordance with the CHIP related
Balanced Budget Act legislation provisions, and to track, monitor, and
evaluate the numbers of related children being served by the Medicaid
and CHIP programs; Form Number: CMS-21 and CMS-21B (OMB 0938-
0731); Frequency: Quarterly; Affected Public: State, Local or Tribal
Gov.; Number of Respondents: 56; Total Annual Responses: 448; Total
Annual Hours: 7,840.
6. Type of Information Request: Revision of a currently approved
collection; Title of Information Collection: Quarterly Medicaid
Statement of Expenditures for the Medical Assistance Program; Use: The
State Medicaid agencies use the form CMS-64 for the Medical Assistance
Program to report their actual program benefit costs and administrative
expenses to CMS. CMS uses this information to compute the Federal
financial participation for the State's Medicaid Program costs. The
structure of the current from CMS-64 has evolved from the previous
forms used for reporting and has been revised. Classification,
identification, and referencing used in the CMS-64 forms has been in
place for several years, is readily understood and accepted by the
report users, and is supported by strong sentiments in both CMS and the
States to maintain the existing format. Therefore, our modifications
have been made to maintain the current reporting format by
incorporating all changes into the existing report structure; Form
Number: CMS-64 (OMB 0938-0067); Frequency: Quarterly; Affected
Public: State, Local or Tribal Gov.; Number of Respondents: 56; Total
Annual Responses: 224; Total Annual Hours: 16,464.
7. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare and
Medicaid Programs; Use and Reporting OASIS Data as Part of the CoPs for
HHAs and Supporting Regulations in 42 CFR 484.11 and 484.20; Form No.:
CMS-R-209 (OMB 0938-0761); Use: HHAs are required to report
data from the OASIS as a condition of participation. Specifically, the
above named regulation sections provide guidelines for HHAs for the
electronic transmission of the OASIS data as well as responsibilities
of the State agency or OASIS contractor in collecting and transmitting
this information to CMS. These requirements are necessary to achieve
broad-based, measurable improvement, in the quality of care furnished
through Federal programs, and to establish a prospective payment system
for HHAs; Frequency: Monthly; Affected Public: Business or other-for-
profit, Federal Government, State, Local or Tribal Government, Not-for-
profit institutions; Number of Respondents: 7,582; Total Annual
Responses: 93,621; Total Annual Hours: 921,271.
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, access CMS'
Web site address at https://www.cms.hhs.gov/regulations/pra/, or E-mail
your request, including your address, phone number, OMB number, and CMS
document identifier, to Paperwork@cms.hhs.gov, or call the Reports
Clearance Office on (410) 786-1326.
Written comments and recommendations for the proposed information
collections must be mailed within 60 days of this notice directly to
the CMS Paperwork Reduction Act Reports Clearance Officer designated at
the address below: CMS, Office of Strategic Operations and Regulatory
Affairs, Division of Regulations Development, Attention: Melissa
Musotto, Room C5-14-03, 7500 Security Boulevard, Baltimore, Maryland
21244-1850.
Dated: January 13, 2005.
Dawn Willinghan,
Acting, CMS Paperwork Reduction Act Reports Clearance Officer, Office
of Strategic Operations and Regulatory Affairs, Regulations Development
Group.
[FR Doc. 05-1320 Filed 1-24-05; 8:45 am]
BILLING CODE 4120-03-M
