Agency Information Collection Activities: Proposed Collection; Comment Request, 34758-34759 [E9-17079]
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34758
Federal Register / Vol. 74, No. 136 / Friday, July 17, 2009 / Notices
1. Type of Information Collection
Request: New Collection; Title of
Information Collection: Children’s
Health Insurance Program
Reauthorization Act (CHIPRA) of 2009,
State Option Pre-print to Include
Pregnant Women in Title XXI; Use:
Section 111 of CHIPRA adds a new
section 2112 to the Social Security Act
which gives States the option of
providing necessary prenatal, delivery
and postpartum care to low-income
uninsured pregnant women through an
amendment to its State Child Health
Plan (CHIP plan). The purpose of this
draft State plan amendment template is
to provide States with the format
needed to enable a State to amend their
CHIP plan to reflect the coverage of
pregnant women. Form Number: CMS–
10284 (OMB#: 0938–NEW); Frequency:
Reporting—One-time and Occasionally;
Affected Public: State, Local or Tribal
Government; Number of Respondents:
40; Total Annual Responses: 40; Total
Annual Hours: 3,200. (For policy
questions regarding this collection
contact Meredith Robertson at 410–786–
6543. For all other issues call 410–786–
1326.)
2. Type of Information Collection
Request: Reinstatement without change
of a previously approved collection;
Title of Information Collection:
Statement of Deficiencies and Plan of
Correction; Use: The information from
the CMS–2567 is used by the States and
CMS regional offices to document and
certify compliance. Form Number:
CMS–2567 (OMB#: 0938–0391);
Frequency: Reporting—Annually;
Affected Public: State, Local or Tribal
Government, Federal Government,
Business or other for-profits and Notfor-profit Institutions; Number of
Respondents: 60,000; Total Annual
Responses: 60,000; Total Annual Hours:
120,000. (For policy questions regarding
this collection contact Joanne Perry at
410–786–3336. For all other issues call
410–786–1326.)
3. Type of Information Collection
Request: New Collection; Title of
Information Collection: State Plan
Amendment Template for Transitional
Medical Assistance for Low-Income
Families; Use: Section 5004 of the
American Recovery and Reinvestment
Act of 2009, Public Law 111–5, amends
section 1925 of the Social Security Act
effective July 1, 2009 to offer States two
new options for eligibility requirements
under Transitional Medical Assistance.
To select either or both of these options
a State Medicaid Agency will complete
the template page and submit it for
approval as part of a State plan
amendment. The law also imposes new
reporting requirements for States which
VerDate Nov<24>2008
19:20 Jul 16, 2009
Jkt 217001
are mentioned on the template. Form
Number: CMS–10283 (OMB#: 0938–
NEW); Frequency: Reporting—One-time
and Occasionally; Affected Public: State,
Local or Tribal Government; Number of
Respondents: 51; Total Annual
Responses: 51; Total Annual Hours: 51.
(For policy questions regarding this
collection contact Mary Corddry at 410–
786–6618. 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
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 August 17, 2009: OMB, Office of
Information and Regulatory Affairs
Attention: CMS Desk Officer, Fax
Number: (202) 395–6974.
E-mail:
OIRA_submission@omb.eop.gov.
Dated: July 9, 2009.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. E9–17080 Filed 7–16–09; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–10260, CMS–R–
72, CMS–10180 and CMS–R–199]
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
PO 00000
Frm 00049
Fmt 4703
Sfmt 4703
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: Revision of a currently
approved collection; Title of
Information Collection: Medicare
Advantage and Prescription Drug
Program: Final Marketing Provisions
CFR 422.111(a)(3) and 423.128(a)(3)
Use: Medicare Advantage (MA) plans
must provide notice to plan members of
impending changes to plan benefits,
premiums and copays in the coming
year so that members will be in the best
position to make an informed choice on
continued enrollment or disenrollment
from that plan at least 15 days before the
Annual Election Period (AEP).
Beginning 2009, organizations will be
required to notify plan members of the
coming year changes using a combined
standardized document at the time of
enrollment and annually thereafter.
Section 422.111 requires, to the extent
that a MA plan has a website, annual
notification through the Web site of
written, hard copy notification sent to
the beneficiaries. Section 423.128
requires that a Part D plan have
mechanisms for providing specific
information on a timely basis to current
and prospective enrollees upon request.
These mechanisms include, Internet
website that includes information on
Part D plan description. MA
organizations (formerly M+C
organizations) and Prescription Drug
Plan Sponsors use the information to
comply with the eligibility requirements
and the MA and Part D contract
requirements. CMS will use this
information to ensure that correct
information is disclosed to Medicare
beneficiaries, both potential enrollees
and enrollees. Form Number: CMS–
10260 (OMB#: 0938–1051); Frequency:
Reporting—Yearly; Affected Public:
Business or other for-profits ; Number of
Respondents: 740; Total Annual
Responses: 740; Total Annual Hours:
8,880. (For policy questions regarding
this collection contact Camille Brown at
410–786–0274. For all other issues call
410–786–1326.)
2. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Information
Collection Requirements in 42 CFR
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mstockstill on DSKH9S0YB1PROD with NOTICES
Federal Register / Vol. 74, No. 136 / Friday, July 17, 2009 / Notices
478.18, 478.34, 478.36, 478.42, QIO
Reconsiderations and Appeals; Use: In
the event that a beneficiary, provider,
physician, or other practitioner does not
agree with the initial determination of a
Quality Improvement Organization
(QIO) or a QIO subcontractor, it is
within that party’s rights to request
reconsideration. The information
collection requirements 42 CFR 478.18,
478.34, 478.36, and 478.42, contain
procedures for QIOs to use in
reconsideration of initial
determinations. The information
requirements contained in these
regulations are on QIOs to provide
information to parties requesting the
reconsideration. These parties will use
the information as guidelines for appeal
rights in instances where issues are
actively being disputed.; Form Number:
CMS–R–72 (OMB#: 0938–0443);
Frequency: Reporting—On occasion;
Affected Public: Individuals or
Households and Business or other forprofit institutions; Number of
Respondents: 2,590; Total Annual
Responses: 5,228; Total Annual Hours:
2,822. (For policy questions regarding
this collection contact Tom Kessler at
410–786–1991. For all other issues call
410–786–1326.)
3. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Children’s
Health Insurance Program (CHIP) Report
on Payables and Receivables; Use:
Collection of CHIP data and the
calculation of the CHIP Incurred But
Not Reported (IBNR) estimate are
pertinent to CMS’ financial audit. The
CFO auditors have reported the lack of
an estimate for CHIP IBNR payables and
receivables as a reportable condition in
the FY 2005 audit of CMS’s financial
statements. It is essential that CMS
collect the necessary data from State
agencies in FY 2006, so that CMS
continues to receive an unqualified
audit opinion on its financial
statements. Program expenditures for
the CHIP have increased since its
inception; as such, CHIP receivables and
payables may materially impact the
financial statements. The CHIP Report
on Payables and Receivables will
provide the information needed to
calculate the CHIP IBNR.; Form
Number: CMS–10180 (OMB#: 0938–
0988); Frequency: Reporting—Annually;
Affected Public: State, Local or Tribal
governments; Number of Respondents:
56; Total Annual Responses: 56; Total
Annual Hours: 336. (For policy
questions regarding this collection
contact Deborah McCleod at 410–786–
VerDate Nov<24>2008
19:20 Jul 16, 2009
Jkt 217001
0013. For all other issues call 410–786–
1326.)
4. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Medicaid Report
on Payables and Receivables; Use: The
Chief Financial Officers (CFO) Act of
1990, as amended by the Government
Management Reform Act (GMRA) of
1994, requires government agencies to
produce auditable financial statements.
Because the Centers for Medicare &
Medicaid Services (CMS) fulfills its
mission through its contractors and the
States; these entities are the primary
source of information for the financial
statements. There are three basic
categories of data: expenses, payables,
and receivables. The CMS–64 is used to
collect data on Medicaid expenses. The
CMS–R–199 collects Medicaid payable
and receivable accounting data from the
States.; Form Number: CMS–R–199
(OMB#: 0938–0697); Frequency:
Reporting—Annually; Affected Public:
State, Local or Tribal governments;
Number of Respondents: 56; Total
Annual Responses: 56; Total Annual
Hours: 336. (For policy questions
regarding this collection contact
Deborah McCleod at 410–786–0013. 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 September 15, 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, Room C4–26–05, 7500
Security Boulevard, Baltimore,
Maryland 21244–1850.
PO 00000
Frm 00050
Fmt 4703
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34759
Dated: July 9, 2009.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. E9–17079 Filed 7–16–09; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Health Resources and Services
Administration
Agency Information Collection
Activities: Submission for OMB
Review; Comment Request
Periodically, the Health Resources
and Services Administration (HRSA)
publishes abstracts of information
collection requests under review by the
Office of Management and Budget
(OMB), in compliance with the
Paperwork Reduction Act of 1995 (44
U.S.C. Chapter 35). To request a copy of
the clearance requests submitted to
OMB for review, e-mail
paperwork@hrsa.gov or call the HRSA
Reports Clearance Office on (301) 443–
1129.
The following request has been
submitted to the Office of Management
and Budget for review under the
Paperwork Reduction Act of 1995:
Proposed Project Title: Interim
Evaluation of the Bright Futures for
Women’s Health and Wellness
(BFWHW) Initiative, Emotional
Wellness Consumer Tools—NEW.
Purpose: The purpose of this project
is to design and implement a three-year
interim evaluation to address initial
outcomes for the BFWHW emotional
wellness tools targeted to consumers.
The project is funded by the Health
Resources and Services Administration
(HRSA), Office of Women’s Health
(OWH). The evaluation will seek to
determine (1) the acceptability of the
tools by the target audiences, (2)
strategies for ensuring their ongoing use,
and (3) the outcomes associated with
the use of these tools in three to four
selected primary care sites.
The evaluation team will work with
HRSA OWH and an Expert Committee
to identify the questions of interest for
the evaluation plan and methodology.
There will be two major components—
a descriptive/process component
focusing on the design and
implementation of the program’s
intervention and an impact component
focusing on the preliminary outcomes of
the intervention on the target audiences
and their behavioral intentions.
E:\FR\FM\17JYN1.SGM
17JYN1
]]>Agencies
[Federal Register Volume 74, Number 136 (Friday, July 17, 2009)]
[Notices]
[Pages 34758-34759]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E9-17079]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10260, CMS-R-72, CMS-10180 and CMS-R-199]
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: Revision of a currently
approved collection; Title of Information Collection: Medicare
Advantage and Prescription Drug Program: Final Marketing Provisions CFR
422.111(a)(3) and 423.128(a)(3) Use: Medicare Advantage (MA) plans must
provide notice to plan members of impending changes to plan benefits,
premiums and copays in the coming year so that members will be in the
best position to make an informed choice on continued enrollment or
disenrollment from that plan at least 15 days before the Annual
Election Period (AEP). Beginning 2009, organizations will be required
to notify plan members of the coming year changes using a combined
standardized document at the time of enrollment and annually
thereafter.
Section 422.111 requires, to the extent that a MA plan has a
website, annual notification through the Web site of written, hard copy
notification sent to the beneficiaries. Section 423.128 requires that a
Part D plan have mechanisms for providing specific information on a
timely basis to current and prospective enrollees upon request. These
mechanisms include, Internet website that includes information on Part
D plan description. MA organizations (formerly M+C organizations) and
Prescription Drug Plan Sponsors use the information to comply with the
eligibility requirements and the MA and Part D contract requirements.
CMS will use this information to ensure that correct information is
disclosed to Medicare beneficiaries, both potential enrollees and
enrollees. Form Number: CMS-10260 (OMB: 0938-1051); Frequency:
Reporting--Yearly; Affected Public: Business or other for-profits ;
Number of Respondents: 740; Total Annual Responses: 740; Total Annual
Hours: 8,880. (For policy questions regarding this collection contact
Camille Brown at 410-786-0274. For all other issues call 410-786-1326.)
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Information
Collection Requirements in 42 CFR
[[Page 34759]]
478.18, 478.34, 478.36, 478.42, QIO Reconsiderations and Appeals; Use:
In the event that a beneficiary, provider, physician, or other
practitioner does not agree with the initial determination of a Quality
Improvement Organization (QIO) or a QIO subcontractor, it is within
that party's rights to request reconsideration. The information
collection requirements 42 CFR 478.18, 478.34, 478.36, and 478.42,
contain procedures for QIOs to use in reconsideration of initial
determinations. The information requirements contained in these
regulations are on QIOs to provide information to parties requesting
the reconsideration. These parties will use the information as
guidelines for appeal rights in instances where issues are actively
being disputed.; Form Number: CMS-R-72 (OMB: 0938-0443);
Frequency: Reporting--On occasion; Affected Public: Individuals or
Households and Business or other for-profit institutions; Number of
Respondents: 2,590; Total Annual Responses: 5,228; Total Annual Hours:
2,822. (For policy questions regarding this collection contact Tom
Kessler at 410-786-1991. For all other issues call 410-786-1326.)
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Children's Health
Insurance Program (CHIP) Report on Payables and Receivables; Use:
Collection of CHIP data and the calculation of the CHIP Incurred But
Not Reported (IBNR) estimate are pertinent to CMS' financial audit. The
CFO auditors have reported the lack of an estimate for CHIP IBNR
payables and receivables as a reportable condition in the FY 2005 audit
of CMS's financial statements. It is essential that CMS collect the
necessary data from State agencies in FY 2006, so that CMS continues to
receive an unqualified audit opinion on its financial statements.
Program expenditures for the CHIP have increased since its inception;
as such, CHIP receivables and payables may materially impact the
financial statements. The CHIP Report on Payables and Receivables will
provide the information needed to calculate the CHIP IBNR.; Form
Number: CMS-10180 (OMB: 0938-0988); Frequency: Reporting--
Annually; Affected Public: State, Local or Tribal governments; Number
of Respondents: 56; Total Annual Responses: 56; Total Annual Hours:
336. (For policy questions regarding this collection contact Deborah
McCleod at 410-786-0013. For all other issues call 410-786-1326.)
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicaid Report
on Payables and Receivables; Use: The Chief Financial Officers (CFO)
Act of 1990, as amended by the Government Management Reform Act (GMRA)
of 1994, requires government agencies to produce auditable financial
statements. Because the Centers for Medicare & Medicaid Services (CMS)
fulfills its mission through its contractors and the States; these
entities are the primary source of information for the financial
statements. There are three basic categories of data: expenses,
payables, and receivables. The CMS-64 is used to collect data on
Medicaid expenses. The CMS-R-199 collects Medicaid payable and
receivable accounting data from the States.; Form Number: CMS-R-199
(OMB: 0938-0697); Frequency: Reporting--Annually; Affected
Public: State, Local or Tribal governments; Number of Respondents: 56;
Total Annual Responses: 56; Total Annual Hours: 336. (For policy
questions regarding this collection contact Deborah McCleod at 410-786-
0013. 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 September 15, 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, Room C4-26-05, 7500 Security Boulevard, Baltimore,
Maryland 21244-1850.
Dated: July 9, 2009.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. E9-17079 Filed 7-16-09; 8:45 am]
BILLING CODE 4120-01-P
