Agency Information Collection Activities: Proposed Collection; Comment Request, 18222-18223 [2011-7746]
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Federal Register / Vol. 76, No. 63 / Friday, April 1, 2011 / Notices
the State level. HHS must have such
information in order to ascertain
whether market destabilization has a
high likelihood of occurring. Form
Number: CMS–10361 (OMB Control No.
0938–1114); Frequency: Once; Affected
Public: State, local or tribal
governments; Number of Respondents:
20; Number of Responses: 20; Average
Hours per Response: 185; Total Annual
Hours: 3,700. (For policy questions
regarding this collection, contact Carol
Jimenez at (301) 492–4109. For all other
issues regarding this collection, 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 at 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 May 31, 2011:
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: March 28, 2011.
Martique Jones,
Director, Regulations Development Group,
Division B, Office of Strategic Operations and
Regulatory Affairs.
mstockstill on DSKH9S0YB1PROD with NOTICES
[FR Doc. 2011–7742 Filed 3–31–11; 8:45 am]
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier CMS–265–11, CMS–
381, and CMS–10123 and 10124]
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Centers for Medicare &
Medicaid Services.
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: Independent
Renal Dialysis Facility Cost Report; Use:
The Independent Renal Dialysis Facility
Cost Report, is filed annually by
providers participating in the Medicare
program to identify the specific items of
cost and statistics of facility operation
that independent renal dialysis facilities
are required to report. The forms are
revised in accordance with the EndStage Renal Disease Prospective
Payment System Final Rule published
August 12, 2010 which implemented
statutory requirements of the Medicare
Improvements for Patients and
Providers Act (MIPPA), enacted July 15,
2008. Additionally, the forms are
revised to incorporate data previously
reported on the Provider Cost Report
Reimbursement Questionnaire, Form
CMS–339. Form Number: CMS–265–94
(OMB#: 0938–0236); Frequency: Yearly;
Affected Public: Business or other forprofits and Not-for-profit institutions;
Number of Respondents: 5,654 Total
Annual Responses: 5,654; Total Annual
Hours: 367,510 (For policy questions
regarding this collection contact Gail
AGENCY:
PO 00000
Frm 00079
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Duncan at 410–786–7278. For all other
issues call 410–786–1326.)
2. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Identification of
Extension Units of Medicare Approved
Outpatient Physical Therapy/Outpatient
Speech Pathology (OPT/OSP) Providers
and Supporting Regulations in 42 CFR
485.701–485.729; Use: The collected
information is used in conjunction with
42 CFR 485.701 through 485.729
governing the operation of providers of
outpatient physical therapy and speechlanguage pathology services. The
provider uses the form to report to the
State survey agency extension locations
that it has added since the date of last
report. The form is used by the State
survey agencies and by the CMS
regional offices to identify and monitor
extension locations to ensure their
compliance with the Federal
requirements for the providers of
outpatient physical therapy and speechlanguage pathology services; Form
Number: CMS–381 (OMB #: 0938–
0273); Frequency: Annually; Affected
Public: Private Sector; Business or other
for-profit and not-for-profit institutions;
Number of Respondents: 2,960; Total
Annual Responses: 2,960; Total Annual
Hours: 740. (For policy questions
regarding this collection contact Georgia
Johnson at 410–786–6859. For all other
issues call 410–786–1326.)
3. Type of Information Collection
Request: Revision of a currently
approved collection; Title of
Information Collection: Notice of
Provider Non-Coverage (CMS–10123)
and Detailed Explanation of NonCoverage (CMS–10124); Use: The Notice
of Medicare Provider Non-Coverage
(CMS–10123) is used to inform fee-forservice Medicare beneficiaries of the
determination that their provider
services will end, and of their right to
an expedited review of that
determination. The Detailed
Explanation of Non-Coverage (CMS–
10124) is used to provide beneficiaries
who request an expedited determination
with detailed information of why the
services should end. The revised Notice
of Provider Non-Coverage and Detailed
Explanation of Provider Non-Coverage
will no longer require use of the
beneficiary’s Medicare number as a
patient identifier. Instead, when
applicable, providers may use a number
that helps to link the notice with a
related claim. Form Number: CMS–
10123 and 10124 (OMB# 0938–0953);
Frequency: Occasionally; Affected
Public: Business or other for-profit, notfor-profit institutions, and Individuals
or households; Number of Respondents:
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Federal Register / Vol. 76, No. 63 / Friday, April 1, 2011 / Notices
5,314,164; Total Annual Responses:
5,314,194; Total Annual Hours: 885,699.
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 at 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 May 31, 2011:
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: March 25, 2011.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2011–7746 Filed 3–31–11; 8:45 am]
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–R–148 and
CMS–R–266]
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
mstockstill on DSKH9S0YB1PROD with NOTICES
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Jkt 223001
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 without change of a
currently approved collection; Title of
Information Collection: Limitations on
Provider Related Donations and Health
Care Related Taxes; Limitation on
Payments for Disproportionate Share
Hospitals and Supporting Regulations in
42 CFR 433.68, 433.74 and 447.272;
Use: The collected information
collection is necessary to ensure
compliance with sections 1903 and
1923 of the Social Security Act by
helping to prevent payments of Federal
financial participation on amounts
prohibited by statute; Form Number:
CMS–R–148 (OMB#: 0938–0618);
Frequency: Quarterly and occasionally;
Affected Public: State, Local, or Tribal
Governments; Number of Respondents:
50; Total Annual Responses: 40; Total
Annual Hours: 3,200. (For policy
questions regarding this collection
contact Rory Howe at 410–786–4878.
For all other issues call 410–786–1326.)
2. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Medicaid
Disproportionate Share Hospital Annual
Reporting; Use: Section 1923(j)(i) of the
Social Security Act (Act) requires States
to submit an annual report that
identifies each disproportionate share
hospital (DSH) that received a DSH
payment under the State’s Medicaid
program in the preceding fiscal year and
the amount of DSH payments paid to
that hospital in the same year along
with other information that the
Secretary determines necessary to
ensure the appropriateness of DSH
payments. The collected information
will also satisfy the requirements under
section 1923(a)(2)(D) of the Act; Form
Number: CMS–R–266 (OMB#: 0938–
0746); Frequency: Yearly; Affected
Public: State, Local, or Tribal
Governments; Number of Respondents:
52; Total Annual Responses: 52; Total
Annual Hours: 1,976. (For policy
questions regarding this collection
contact Rory Howe at 410–786–4878.
For all other issues call 410–786–1326.)
PO 00000
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18223
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
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 May 2, 2011 OMB, Office of
Information and Regulatory Affairs,
Attention: CMS Desk Officer, Fax
Number: (202) 395–6974, E-mail:
OIRA_submission@omb.eop.gov.
Dated: March 25, 2011.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2011–7747 Filed 3–31–11; 8:45 am]
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Proposed Information Collection
Activity; Comment Request
Title: Descriptive Study of Early Head
Start (Early Head Start Family and Child
Experiences Study; Baby FACES).
OMB No.: 0970–0354
Description: The Administration for
Children and Families (ACF), U.S.
Department of Health and Human
Services (HHS), anticipates continuing
data collection for wave 4 of the parent
interview, teacher child reports, care
provider interviews and observations,
direct child assessments, program
director interviews, and family service
tracking for the peri-natal cohort of the
Descriptive Study of Early Head Start
(Early Head Start Family and Child
Experiences Study; Baby FACES). Data
collection will continue for an
additional 12 months beyond the
current date of expiration (October 31,
2011).
This data collection is a part of Baby
FACES, which is an important
opportunity to provide a description of
the characteristics, experiences, and
outcomes of Early Head Start children
and families, and Early Head Start
Program services and delivery. All of
the information obtained will be used to
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]]>Agencies
[Federal Register Volume 76, Number 63 (Friday, April 1, 2011)]
[Notices]
[Pages 18222-18223]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-7746]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier CMS-265-11, CMS-381, and CMS-10123 and 10124]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare & Medicaid Services.
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: Independent Renal
Dialysis Facility Cost Report; Use: The Independent Renal Dialysis
Facility Cost Report, is filed annually by providers participating in
the Medicare program to identify the specific items of cost and
statistics of facility operation that independent renal dialysis
facilities are required to report. The forms are revised in accordance
with the End-Stage Renal Disease Prospective Payment System Final Rule
published August 12, 2010 which implemented statutory requirements of
the Medicare Improvements for Patients and Providers Act (MIPPA),
enacted July 15, 2008. Additionally, the forms are revised to
incorporate data previously reported on the Provider Cost Report
Reimbursement Questionnaire, Form CMS-339. Form Number: CMS-265-94
(OMB: 0938-0236); Frequency: Yearly; Affected Public: Business
or other for-profits and Not-for-profit institutions; Number of
Respondents: 5,654 Total Annual Responses: 5,654; Total Annual Hours:
367,510 (For policy questions regarding this collection contact Gail
Duncan at 410-786-7278. For all other issues call 410-786-1326.)
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Identification of
Extension Units of Medicare Approved Outpatient Physical Therapy/
Outpatient Speech Pathology (OPT/OSP) Providers and Supporting
Regulations in 42 CFR 485.701-485.729; Use: The collected information
is used in conjunction with 42 CFR 485.701 through 485.729 governing
the operation of providers of outpatient physical therapy and speech-
language pathology services. The provider uses the form to report to
the State survey agency extension locations that it has added since the
date of last report. The form is used by the State survey agencies and
by the CMS regional offices to identify and monitor extension locations
to ensure their compliance with the Federal requirements for the
providers of outpatient physical therapy and speech-language pathology
services; Form Number: CMS-381 (OMB : 0938-0273); Frequency:
Annually; Affected Public: Private Sector; Business or other for-profit
and not-for-profit institutions; Number of Respondents: 2,960; Total
Annual Responses: 2,960; Total Annual Hours: 740. (For policy questions
regarding this collection contact Georgia Johnson at 410-786-6859. For
all other issues call 410-786-1326.)
3. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Notice of
Provider Non-Coverage (CMS-10123) and Detailed Explanation of Non-
Coverage (CMS-10124); Use: The Notice of Medicare Provider Non-Coverage
(CMS-10123) is used to inform fee-for-service Medicare beneficiaries of
the determination that their provider services will end, and of their
right to an expedited review of that determination. The Detailed
Explanation of Non-Coverage (CMS-10124) is used to provide
beneficiaries who request an expedited determination with detailed
information of why the services should end. The revised Notice of
Provider Non-Coverage and Detailed Explanation of Provider Non-Coverage
will no longer require use of the beneficiary's Medicare number as a
patient identifier. Instead, when applicable, providers may use a
number that helps to link the notice with a related claim. Form Number:
CMS-10123 and 10124 (OMB 0938-0953); Frequency: Occasionally;
Affected Public: Business or other for-profit, not-for-profit
institutions, and Individuals or households; Number of Respondents:
[[Page 18223]]
5,314,164; Total Annual Responses: 5,314,194; Total Annual Hours:
885,699.
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 at 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 May 31, 2011:
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: March 25, 2011.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. 2011-7746 Filed 3-31-11; 8:45 am]
BILLING CODE 4120-01-P
