Agency Information Collection Activities: Submission for OMB Review; Comment Request, 74817 [05-24112]
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Federal Register / Vol. 70, No. 241 / Friday, December 16, 2005 / Notices
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS 1880/1882, CMS
10142 and CMS 10036]
Agency Information Collection
Activities: Submission for OMB
Review; 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), Department of Health
and Human Services, 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 function;
(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: The Request for
Certification as a Supplier of Portable
X–Ray Services and Portable X–Ray
Survey Report Form under the Medicare
and Medicaid Program—Portable X–Ray
Survey Report and Supporting
Regulations under 42 CFR 486.100–
486.110; Form Number: CMS–1880/
1882 (OMB#: 0938–0027); Use: The
Medicare program requires portable Xray suppliers to be surveyed for health
and safety standards. The CMS–1882 is
the survey form that records survey
results. The CMS–1880 is used by the
surveyor to determine if a portable X-ray
applicant meets the eligibility
requirements. This information serves
as a screen for the State survey agency
to determine if the portable X-ray
supplier has the basic capabilities to
participate in the Medicare program.
CMS will use this information to make
certification decisions; Frequency:
Reporting—On occasion; Affected
Public: Business or other for-profit;
Number of Respondents: 655; Total
Annual Responses: 98; Total Annual
Hours: 172.
AGENCY:
VerDate Aug<31>2005
19:37 Dec 15, 2005
Jkt 208001
2. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Bid Pricing Tool
(BPT) for Medicare Advantage and
Prescription Drug Plans (PDP) contained
in 42 Code of Federal Regulation (CFR):
422.250, 422.252, 422.254, 422.256,
422.258, 422.262, 422.264, 422.266,
422.270, 422.300, 422.304, 422.306,
422.308, 422.310, 422.312, 422.314,
422.316, 422.318, 422.320, 422.322,
422.324, 423.251, 423.258, 423.265,
423.272, 423.279, 423.286, 423.293,
423.301, 423.308, 423.315, 423.322,
423.329, 423.336, 423.343, 423.346,
423.350; Form Number: CMS–10142
(OMB#: 0938–0944); Use: Under the
Medicare Modernization Act, Medicare
Advantage Organizations (MAO) and
Prescription Drug Plans (PDP) are
required to submit an actuarial pricing
bid to CMS for approval. The BPT
software is used by MAOs and PDPs to
price their plan benefit package. The
BPT software is used by CMS to review
and approve the plan pricing proposed
by each organization; Frequency:
Reporting—On occasion, Annually and
As required by new legislation; Affected
Public: Business or other for-profit and
Not-for-profit institutions; Number of
Respondents: 350; Total Annual
Responses: 350; Total Annual Hours:
12,050.
3. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Inpatient
Rehabilitation Assessment Instrument
and Data Set for Prospective Payment
System for Inpatient Rehabilitation
Facilities and Supporting Regulations in
42 CFR Sections 412.23, 412.604,
412.606, 412.610, 412.614, 412.618,
412.626, 413.64; Form Number: CMS–
10036 (OMB#: 0938–0842); Use: This is
a request to use the Inpatient
Rehabilitation Facilities-Patient
Assessment Instrument (IRF–PAI) and
its supporting manual for the
implementation phase of the Inpatient
Rehabilitation) Prospective Payment
System (PPS). This payment system is to
cover both operating and capital costs
for inpatient rehabilitation hospital
services. It will apply to rehabilitation
units of acute care hospitals as well as
to rehabilitation hospitals, both of
which are exempt from the current
Inpatient PPS which is generally
applicable for inpatient hospital
services. Use of this instrument will
enable CMS to implement a
classification and payment system for
the legislatively mandated inpatient
rehabilitation hospital and the
aforementioned exempt units.
PO 00000
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74817
Frequency: Recordkeeping, Third party
disclosure and Reporting—On occasion;
Affected Public: Business or other forprofit and Not-for-profit institutions;
Number of Respondents: 1,165; Total
Annual Responses: 390,000; Total
Annual Hours: 421,939.
To obtain copies of the supporting
statement and any related forms for
these 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.
To be assured consideration,
comments and recommendations for the
proposed information collections must
be received by the OMB Desk Officer at
the address below, no later than 5 p.m.
on January 17, 2006.
OMB Human Resources and Housing
Branch, Attention: Carolyn Lovett, CMS
Desk Officer, New Executive Office
Building, Room 10235, Washington, DC
20503.
Dated: December 9, 2005.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. 05–24112 Filed 12–15–05; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
[Docket No. 2003N–0273]
Agency Information Collection
Activities; Submission for Office of
Management and Budget Review;
Comment Request; Research Study
Complaint Form
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 17,
2006.
ADDRESSES: OMB is still experiencing
significant delays in the regular mail,
including first class and express mail,
and messenger deliveries are not being
E:\FR\FM\16DEN1.SGM
16DEN1
]]>Agencies
[Federal Register Volume 70, Number 241 (Friday, December 16, 2005)]
[Notices]
[Page 74817]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-24112]
[[Page 74817]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS 1880/1882, CMS 10142 and CMS 10036]
Agency Information Collection Activities: Submission for OMB
Review; 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), Department of Health and Human Services, 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 function; (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: The Request for
Certification as a Supplier of Portable X-Ray Services and Portable X-
Ray Survey Report Form under the Medicare and Medicaid Program--
Portable X-Ray Survey Report and Supporting Regulations under 42 CFR
486.100-486.110; Form Number: CMS-1880/1882 (OMB: 0938-0027);
Use: The Medicare program requires portable X-ray suppliers to be
surveyed for health and safety standards. The CMS-1882 is the survey
form that records survey results. The CMS-1880 is used by the surveyor
to determine if a portable X-ray applicant meets the eligibility
requirements. This information serves as a screen for the State survey
agency to determine if the portable X-ray supplier has the basic
capabilities to participate in the Medicare program. CMS will use this
information to make certification decisions; Frequency: Reporting--On
occasion; Affected Public: Business or other for-profit; Number of
Respondents: 655; Total Annual Responses: 98; Total Annual Hours: 172.
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Bid Pricing Tool
(BPT) for Medicare Advantage and Prescription Drug Plans (PDP)
contained in 42 Code of Federal Regulation (CFR): 422.250, 422.252,
422.254, 422.256, 422.258, 422.262, 422.264, 422.266, 422.270, 422.300,
422.304, 422.306, 422.308, 422.310, 422.312, 422.314, 422.316, 422.318,
422.320, 422.322, 422.324, 423.251, 423.258, 423.265, 423.272, 423.279,
423.286, 423.293, 423.301, 423.308, 423.315, 423.322, 423.329, 423.336,
423.343, 423.346, 423.350; Form Number: CMS-10142 (OMB: 0938-
0944); Use: Under the Medicare Modernization Act, Medicare Advantage
Organizations (MAO) and Prescription Drug Plans (PDP) are required to
submit an actuarial pricing bid to CMS for approval. The BPT software
is used by MAOs and PDPs to price their plan benefit package. The BPT
software is used by CMS to review and approve the plan pricing proposed
by each organization; Frequency: Reporting--On occasion, Annually and
As required by new legislation; Affected Public: Business or other for-
profit and Not-for-profit institutions; Number of Respondents: 350;
Total Annual Responses: 350; Total Annual Hours: 12,050.
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Inpatient
Rehabilitation Assessment Instrument and Data Set for Prospective
Payment System for Inpatient Rehabilitation Facilities and Supporting
Regulations in 42 CFR Sections 412.23, 412.604, 412.606, 412.610,
412.614, 412.618, 412.626, 413.64; Form Number: CMS-10036
(OMB: 0938-0842); Use: This is a request to use the Inpatient
Rehabilitation Facilities-Patient Assessment Instrument (IRF-PAI) and
its supporting manual for the implementation phase of the Inpatient
Rehabilitation) Prospective Payment System (PPS). This payment system
is to cover both operating and capital costs for inpatient
rehabilitation hospital services. It will apply to rehabilitation units
of acute care hospitals as well as to rehabilitation hospitals, both of
which are exempt from the current Inpatient PPS which is generally
applicable for inpatient hospital services. Use of this instrument will
enable CMS to implement a classification and payment system for the
legislatively mandated inpatient rehabilitation hospital and the
aforementioned exempt units. Frequency: Recordkeeping, Third party
disclosure and Reporting--On occasion; Affected Public: Business or
other for-profit and Not-for-profit institutions; Number of
Respondents: 1,165; Total Annual Responses: 390,000; Total Annual
Hours: 421,939.
To obtain copies of the supporting statement and any related forms
for these 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.
To be assured consideration, comments and recommendations for the
proposed information collections must be received by the OMB Desk
Officer at the address below, no later than 5 p.m. on January 17, 2006.
OMB Human Resources and Housing Branch, Attention: Carolyn Lovett,
CMS Desk Officer, New Executive Office Building, Room 10235,
Washington, DC 20503.
Dated: December 9, 2005.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. 05-24112 Filed 12-15-05; 8:45 am]
BILLING CODE 4120-01-P
