Agency Information Collection Activities: Proposed Collection; Comment Request, 29248 [2011-12472]
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29248
Federal Register / Vol. 76, No. 98 / Friday, May 20, 2011 / Notices
the following issues. The CMS–855A
enrollment form currently captures
ownership/managerial information on
providers. The data required under
sections 6401 and 6001, however, is
more specific than that currently
obtained on the CMS–855A. CMS will
therefore create four attachments to the
CMS–855A—two for SNFs and the other
two for physician-owned hospitals—to
secure this information. In addition to
the application changes triggered by
ACA, CMS is making other revisions to
the forms as well.
This information collection request
has been revised since the 60-day
Federal Register notice published on
March 22, 2011 (76 FR 13415). The
group/clinic and individual burden has
decreased due to the removal of a
previously proposed supplier
attachment. However, the overall
burden hour estimate has increased
slightly due to additional role-specific
ownership and managerial control data
collection for institutional providers.
Form Number: CMS–855(A, B, I, R)
(OMB#: 0938–0685); Frequency: Yearly;
Affected Public: Private Sector; Business
or other for-profit and not-for-profit
institutions; Number of Respondents:
440,450; Total Annual Responses:
440,450; Total Annual Hours: 856,395.
(For policy questions regarding this
collection contact Kim McPhillips at
410–786–5374. For all other issues call
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 June 20, 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: May 17, 2011.
Martique Jones,
Director, Regulations Development Group,
Division-B, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2011–12473 Filed 5–19–11; 8:45 am]
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
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Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–R–235]
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Centers for Medicare &
Medicaid Services, HHS.
AGENCY:
VerDate Mar<15>2010
18:05 May 19, 2011
Jkt 223001
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: Data Use
Agreement (DUA) for Data Acquired
from the Centers for Medicare &
Medicaid Services (CMS); Use: The
Privacy Act of 1976, § 552a requires the
Centers for Medicare & Medicaid
Services (CMS) to track all disclosures
of the agency’s Personally Identifiable
Information (PII) and the exceptions for
these data releases. CMS is also required
by the Health Insurance Portability and
Accountability Act (HIPAA) of 1996 and
the Federal Information Security
Management Act (FISMA) of 2002 to
properly protect all PII data maintained
by the agency. When entities request
CMS PII data, they enter into a Data Use
Agreement (DUA) with CMS. The DUA
stipulates that the recipient of CMS PII
data must properly protect the data
according to FISMA and also provide
for its appropriate destruction at the
completion of the project/study or the
expiration date of the DUA. The DUA
form enables the data recipient and
CMS to document the request and
approval for release of CMS PII data.
The form requires the submitter to
provide the Requestor’s organization;
project/study name; CMS contract
number (if applicable); data descriptions
and the years of the data; retention date;
attachments to the agreement; name,
title, contact information to include
address, city, state, zip code, phone, email, signature and date signed by the
requester and custodian; disclosure
provision; name of Federal Agency
sponsor; Federal Representative name,
title, contact information, signature,
date; CMS representative name, title,
contact information, signature and date;
PO 00000
Frm 00058
Fmt 4703
Sfmt 4703
and concurrence/non-concurrence
signatures and dates from 3 CMS
System Manager or Business Owners.
While the data elements collected are
not subject to change, the
individualized clauses that are
incorporated into any specific DUA are
subject to change based on a specific
case or situation such as disclosures to
states, oversight agencies or DUAs for
disproportionate share hospital (DSH)
data requests as well as updates to
DUAs with additional data descriptions,
changes to the requestor or adding
custodians to current DUAs. Form
Number: CMS–R–235 (OCN: 0938–0734)
Frequency: Once; Affected Public:
Private Sector—Business or other Forprofits and Not-for-profit Institutions;
Number of Respondents: 2,200; Number
of Responses: 2,200; Total Annual
Hours: 916. (For policy questions
regarding this collection, contact Sharon
Kavanagh at 410–786–5441. 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.gov/Paperwork
ReductionActof1995/PRAL/
list.asp#TopOfPage 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 July 19, 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: May 17, 2011.
Martique Jones,
Director, Regulations Development Group,
Division B, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2011–12472 Filed 5–19–11; 8:45 am]
BILLING CODE 4120–01–P
E:\FR\FM\20MYN1.SGM
20MYN1
Agencies
[Federal Register Volume 76, Number 98 (Friday, May 20, 2011)]
[Notices]
[Page 29248]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-12472]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-R-235]
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: Data Use
Agreement (DUA) for Data Acquired from the Centers for Medicare &
Medicaid Services (CMS); Use: The Privacy Act of 1976, Sec. 552a
requires the Centers for Medicare & Medicaid Services (CMS) to track
all disclosures of the agency's Personally Identifiable Information
(PII) and the exceptions for these data releases. CMS is also required
by the Health Insurance Portability and Accountability Act (HIPAA) of
1996 and the Federal Information Security Management Act (FISMA) of
2002 to properly protect all PII data maintained by the agency. When
entities request CMS PII data, they enter into a Data Use Agreement
(DUA) with CMS. The DUA stipulates that the recipient of CMS PII data
must properly protect the data according to FISMA and also provide for
its appropriate destruction at the completion of the project/study or
the expiration date of the DUA. The DUA form enables the data recipient
and CMS to document the request and approval for release of CMS PII
data. The form requires the submitter to provide the Requestor's
organization; project/study name; CMS contract number (if applicable);
data descriptions and the years of the data; retention date;
attachments to the agreement; name, title, contact information to
include address, city, state, zip code, phone, e-mail, signature and
date signed by the requester and custodian; disclosure provision; name
of Federal Agency sponsor; Federal Representative name, title, contact
information, signature, date; CMS representative name, title, contact
information, signature and date; and concurrence/non-concurrence
signatures and dates from 3 CMS System Manager or Business Owners.
While the data elements collected are not subject to change, the
individualized clauses that are incorporated into any specific DUA are
subject to change based on a specific case or situation such as
disclosures to states, oversight agencies or DUAs for disproportionate
share hospital (DSH) data requests as well as updates to DUAs with
additional data descriptions, changes to the requestor or adding
custodians to current DUAs. Form Number: CMS-R-235 (OCN: 0938-0734)
Frequency: Once; Affected Public: Private Sector--Business or other
For-profits and Not-for-profit Institutions; Number of Respondents:
2,200; Number of Responses: 2,200; Total Annual Hours: 916. (For policy
questions regarding this collection, contact Sharon Kavanagh at 410-
786-5441. 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.gov/PaperworkReductionActof1995/PRAL/list.asp#TopOfPage 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 July 19, 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: May 17, 2011.
Martique Jones,
Director, Regulations Development Group, Division B, Office of
Strategic Operations and Regulatory Affairs.
[FR Doc. 2011-12472 Filed 5-19-11; 8:45 am]
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