Agency Information Collection Activities: Proposed Collection; Comment Request, 28249-28250 [E9-13944]

Download as PDF Federal Register / Vol. 74, No. 113 / Monday, June 15, 2009 / Notices within 30 days of publication. Written comments and recommendations for the proposed information collection should be sent directly to the following: Office of Management and Budget, Paperwork Reduction Project, Fax: 202–395–7245, Attn: Desk Officer for the Administration for Children and Families. Dated: June 10, 2009. Janean Chambers, Reports Clearance Officer. [FR Doc. E9–13985 Filed 6–12–09; 8:45 am] BILLING CODE 4184–01–P DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [Document Identifier: CMS–10266] pwalker on PROD1PC71 with NOTICES 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: New collection; Title of Information Collection: Conditions of Participation: Requirements for Approval and Reapproval of Transplant Centers to Perform Organ Transplants and Supporting Regulations in 42 CFR 482.74, 482.94, 482.100, 482.102, 488.61; Use: The Conditions of Participation and accompanying requirements specified in the regulations are used by our surveyors as a basis for determining whether a transplant center qualifies for approval or re-approval under Medicare. CMS VerDate Nov<24>2008 16:47 Jun 12, 2009 Jkt 217001 and the healthcare industry believe that the availability to the facility of the type of records and general content of records is standard medical practice and is necessary in order to ensure the wellbeing and safety of patients and professional treatment accountability. Form Number: CMS–10266 (OMB# 0938–New); Frequency: Yearly; Affected Public: Business or other for-profits and Not-for-profit institutions; Number of Respondents: 514; Total Annual Responses: 3,270; Total Annual Hours: 9,334. 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/ PaperworkReductionActof1995, or email 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 July 15, 2009. OMB Human Resources and Housing Branch, Attention: OMB Desk Officer, New Executive Office Building, Room 10235, Washington, DC 20503, Fax Number: (202) 395–6974. Dated: June 5, 2009. Michelle Shortt, Director, Regulations Development Group, Office of Strategic Operations and Regulatory Affairs. [FR Doc. E9–13947 Filed 6–12–09; 8:45 am] BILLING CODE 4120–01–P DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [Document Identifier: CMS–304/304a, CMS– 10288, CMS–10289 and CMS–1450 (UB–04)] 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 PO 00000 Frm 00037 Fmt 4703 Sfmt 4703 28249 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 without change of a currently approved collection; Title of Information Collection: Reconciliation of State Invoice and Prior Quarter Adjustment Statement; Use: Section 1927 of the Social Security Act requires drug manufacturers to enter into and have in effect a rebate agreement with CMS in order for States to receive funding for drugs dispensed to Medicaid recipients. Drug manufacturers must complete and submit to States the 304 form (the Reconciliation of State Invoice Form) to explain any rebate payment adjustments for the current quarter, and complete and submit the 304A form (the Prior Quarter Adjustment Statement Form) to States to explain rebate payment adjustments to any prior quarters. Both forms are used to reconcile drug rebate payments made by manufacturers with the State invoices of rebates due. Form Number: CMS–304/304a (OMB#: 0938– 0676); Frequency: Reporting—Quarterly; Affected Public: Private Sector: Business or other for profits; Number of Respondents: 570; Total Annual Responses: 3820; Total Annual Hours: 141,080. (For policy questions regarding this collection contact Cindy Bergin at 410–786–1176. For all other issues call 410–786–1326.) 2. Type of Information Collection Request: New Collection; Title of Information Collection: State Plan PrePrint to Implement Required Dental Benefits Pursuant of Children’s Health Insurance Program Reauthorizing Act (CHIPRA) 2009; Use: Section 501 of CHIPRA 2009 amends XXI and requires that ‘‘child health assistance provide to a targeted low-income child shall include coverage of dental services necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions.’’ States that provide coverage in a separate Children’s Health Insurance Program may choose between two methods of providing the dental services required in Section 501. The State may define the E:\FR\FM\15JNN1.SGM 15JNN1 pwalker on PROD1PC71 with NOTICES 28250 Federal Register / Vol. 74, No. 113 / Monday, June 15, 2009 / Notices services in the dental benefit package and demonstrate that it includes all the required services. Alternatively, the State may provide a dental benefit package that is equivalent to one of the three benchmark packages described in the statute. In order to implement one of these options and comply with the statute, States must amend their State Plan using the State Plan pre-print. Form Number: CMS–10288 (OMB #: 0938—NEW); Frequency: Reporting One-time; Affected Public: State, Local, or Tribal Governments; Number of Respondents: 51; Total Annual Responses: 51; Total Annual Hours: 1530. (For policy questions regarding this collection contact Nancy Goetschius at 410–786–0707. For all other issues call 410–786–1326.) 3. Type of Information Collection Request: New Collection; Title of Information Collection: Optional Dentalonly Supplemental Coverage State Plan Amendment Template; Use: CHIPRA 2009 provides States with an option to provide supplemental dental-only coverage to children who would be eligible to enroll in the State’s Children’s Health Insurance Program (CHIP), except that they already have health insurance coverage, either through a group health plan or employer sponsored insurance. If the health insurance plan the child is enrolled in does not provide dental benefits, the State may provide the child with the same State-defined dental package or benchmark benefit plan provided to children who are eligible for the entire CHIP benefit package. The child will only be entitled to the dental services provided to other CHIP children. In order to choose this option, State must comply with all other requirements of the statute regarding cost sharing, income eligibility level, absence of a waiting list for their entire CHIP program (not just for dental coverage), and not providing more favorable treatment to children eligible for the supplemental dental benefit under this option. In order to implement this option States must amend their State Plan using the Supplemental Dental Benefits State Plan Amendment Template. Form Number: CMS–10289 (OMB#: 0938—NEW); Frequency: Reporting One-time; Affected Public: State, local, or Tribal Governments; Number of Respondents: 51; Total Annual Responses: 51; Total Annual Hours: 1020. (For policy questions regarding this collection contact Nancy Goetschius at 410–786–0707. For all other issues call 410–786–1326.) 4. Type of Information Collection Request: Extension of a currently approved collection; Title of VerDate Nov<24>2008 16:47 Jun 12, 2009 Jkt 217001 Information Collection: Medicare Uniform Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5; Use: Section 42 CFR 424.5(a)(5) requires providers of services to submit a claim for payment prior to any Medicare reimbursement. Charges billed are coded by revenue codes. The bill specifies diagnoses according to the International Classification of Diseases, Ninth Edition (ICD–9–CM) code. Inpatient procedures are identified by ICD–9–CM codes, and outpatient procedures are described using the CMS Common Procedure Coding System (HCPCS). These are standard systems of identification for all major health insurance claims payers. Submission of information on the CMS–1450 permits Medicare intermediaries to receive consistent data for proper payment. Form Numbers: CMS–1450 (UB–04) (OMB#: 0938–0997); Frequency: Reporting—On occasion; Affected Public: Not-for-profit institutions, Business or other for-profit; Number of Respondents: 53,111; Total Annual Responses: 181,909,654; Total Annual Hours: 1,567,455. (For policy questions regarding this collection contact Matt Klischer at 410–786–7488. For all other issues call 410–786–1326.) To obtain copies of the supporting statement and any related forms for the proposed paperwork collections referenced above, access CMS’ Web site at https://www.cms.hhs.gov/ PaperworkReductionActof1995, or email 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. In commenting on the proposed information collections please reference the document identifier or OMB control number. To be assured consideration, comments and recommendations must be submitted in one of the following ways by August 14, 2009: 1. Electronically. You may submit 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) 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 (CMS–10078), Room C4–26–05, 7500 Security Boulevard, Baltimore, Maryland 21244–1850. PO 00000 Frm 00038 Fmt 4703 Sfmt 4703 Dated: June 5, 2009. Michelle Shortt, Director, Regulations Development Group, Office of Strategic Operations and Regulatory Affairs. [FR Doc. E9–13944 Filed 6–12–09; 8:45 am] BILLING CODE 4120–01–P DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service [Funding Opportunity Number: HHS–2009– IHS–UIHP–0003] Office of Urban Indian Health Programs Announcement Type: Competitive Targeted Solicitation. Catalog of Federal Domestic Assistance Number: 93.193. Application Deadline Date: July 15, 2009. Review Date: July 30, 2009. Earliest Anticipated Start Date: August 3, 2009. I. Funding Opportunity Description The Indian Health Service (IHS), Office of Urban Indian Health Programs (OUIHP) announces a limited targeted solicitation for the 4-in-1 Title V grants responding to an Office of HIV/AIDS Policy (OHAP), Minority AIDS (Acquired Immunodeficiency Syndrome) Initiative (MAI). This program is authorized under the authority of the Snyder Act and 25 U.S.C. 1652, 1653 of the Indian Health Care Improvement Act, Public Law 94– 437, as amended. This program is described at 93.193 in the Catalog of Federal Domestic Assistance (CFDA). This competitive targeted solicitation seeks to expand OUIHP’s existing Title V grants to increase the number of American Indian/Alaska Natives (AI/ AN) with awareness of his/her HIV status. This will provide routine and/or rapid HIV screening, prevention, preand post-test counseling (when appropriate). Enhancement of urban Indian health program HIV/AIDS activities is necessary to reduce the incidence of HIV/AIDS in the urban Indian health communities by increasing access to HIV related services, reducing stigma, and making testing routine. These grants and supplements will be used to enhance HIV testing, including rapid testing and/or standard HIV antibody testing and to provide a more focused effort to address HIV/AIDS prevention by targeting some of the largest urban Indian populations in the United States. The grantees will attempt E:\FR\FM\15JNN1.SGM 15JNN1

Agencies

[Federal Register Volume 74, Number 113 (Monday, June 15, 2009)]
[Notices]
[Pages 28249-28250]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-13944]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-304/304a, CMS-10288, CMS-10289 and CMS-1450 
(UB-04)]


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 without change 
of a currently approved collection; Title of Information Collection: 
Reconciliation of State Invoice and Prior Quarter Adjustment Statement; 
Use: Section 1927 of the Social Security Act requires drug 
manufacturers to enter into and have in effect a rebate agreement with 
CMS in order for States to receive funding for drugs dispensed to 
Medicaid recipients. Drug manufacturers must complete and submit to 
States the 304 form (the Reconciliation of State Invoice Form) to 
explain any rebate payment adjustments for the current quarter, and 
complete and submit the 304A form (the Prior Quarter Adjustment 
Statement Form) to States to explain rebate payment adjustments to any 
prior quarters. Both forms are used to reconcile drug rebate payments 
made by manufacturers with the State invoices of rebates due. Form 
Number: CMS-304/304a (OMB: 0938-0676); Frequency: Reporting--
Quarterly; Affected Public: Private Sector: Business or other for 
profits; Number of Respondents: 570; Total Annual Responses: 3820; 
Total Annual Hours: 141,080. (For policy questions regarding this 
collection contact Cindy Bergin at 410-786-1176. For all other issues 
call 410-786-1326.)
    2. Type of Information Collection Request: New Collection; Title of 
Information Collection: State Plan Pre-Print to Implement Required 
Dental Benefits Pursuant of Children's Health Insurance Program 
Reauthorizing Act (CHIPRA) 2009; Use: Section 501 of CHIPRA 2009 amends 
XXI and requires that ``child health assistance provide to a targeted 
low-income child shall include coverage of dental services necessary to 
prevent disease and promote oral health, restore oral structures to 
health and function, and treat emergency conditions.'' States that 
provide coverage in a separate Children's Health Insurance Program may 
choose between two methods of providing the dental services required in 
Section 501. The State may define the

[[Page 28250]]

services in the dental benefit package and demonstrate that it includes 
all the required services. Alternatively, the State may provide a 
dental benefit package that is equivalent to one of the three benchmark 
packages described in the statute. In order to implement one of these 
options and comply with the statute, States must amend their State Plan 
using the State Plan pre-print. Form Number: CMS-10288 (OMB : 
0938--NEW); Frequency: Reporting One-time; Affected Public: State, 
Local, or Tribal Governments; Number of Respondents: 51; Total Annual 
Responses: 51; Total Annual Hours: 1530. (For policy questions 
regarding this collection contact Nancy Goetschius at 410-786-0707. For 
all other issues call 410-786-1326.)
    3. Type of Information Collection Request: New Collection; Title of 
Information Collection: Optional Dental-only Supplemental Coverage 
State Plan Amendment Template; Use: CHIPRA 2009 provides States with an 
option to provide supplemental dental-only coverage to children who 
would be eligible to enroll in the State's Children's Health Insurance 
Program (CHIP), except that they already have health insurance 
coverage, either through a group health plan or employer sponsored 
insurance. If the health insurance plan the child is enrolled in does 
not provide dental benefits, the State may provide the child with the 
same State-defined dental package or benchmark benefit plan provided to 
children who are eligible for the entire CHIP benefit package. The 
child will only be entitled to the dental services provided to other 
CHIP children.
    In order to choose this option, State must comply with all other 
requirements of the statute regarding cost sharing, income eligibility 
level, absence of a waiting list for their entire CHIP program (not 
just for dental coverage), and not providing more favorable treatment 
to children eligible for the supplemental dental benefit under this 
option. In order to implement this option States must amend their State 
Plan using the Supplemental Dental Benefits State Plan Amendment 
Template. Form Number: CMS-10289 (OMB: 0938--NEW); Frequency: 
Reporting One-time; Affected Public: State, local, or Tribal 
Governments; Number of Respondents: 51; Total Annual Responses: 51; 
Total Annual Hours: 1020. (For policy questions regarding this 
collection contact Nancy Goetschius at 410-786-0707. For all other 
issues call 410-786-1326.)
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare Uniform 
Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5; 
Use: Section 42 CFR 424.5(a)(5) requires providers of services to 
submit a claim for payment prior to any Medicare reimbursement. Charges 
billed are coded by revenue codes. The bill specifies diagnoses 
according to the International Classification of Diseases, Ninth 
Edition (ICD-9-CM) code. Inpatient procedures are identified by ICD-9-
CM codes, and outpatient procedures are described using the CMS Common 
Procedure Coding System (HCPCS). These are standard systems of 
identification for all major health insurance claims payers. Submission 
of information on the CMS-1450 permits Medicare intermediaries to 
receive consistent data for proper payment. Form Numbers: CMS-1450 (UB-
04) (OMB: 0938-0997); Frequency: Reporting--On occasion; 
Affected Public: Not-for-profit institutions, Business or other for-
profit; Number of Respondents: 53,111; Total Annual Responses: 
181,909,654; Total Annual Hours: 1,567,455. (For policy questions 
regarding this collection contact Matt Klischer at 410-786-7488. For 
all other issues call 410-786-1326.)
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access CMS' 
Web site at https://www.cms.hhs.gov/PaperworkReductionActof1995, 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.
    In commenting on the proposed information collections please 
reference the document identifier or OMB control number. To be assured 
consideration, comments and recommendations must be submitted in one of 
the following ways by August 14, 2009:
    1. Electronically. You may submit 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) 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 (CMS-10078), Room C4-26-05, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850.

    Dated: June 5, 2009.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. E9-13944 Filed 6-12-09; 8:45 am]
BILLING CODE 4120-01-P

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