Agency Information Collection Activities: Submission for OMB Review; Comment Request, 30944 [2011-13039]
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30944
Federal Register / Vol. 76, No. 103 / Friday, May 27, 2011 / Notices
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–222, CMS–287–
05, CMS–1771, and CMS–10008]
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 currently
approved collection; Title of
Information Collection: Independent
Rural Health Center/Freestanding
Federally Qualified Health Center Cost
Report and Supporting Regulations 42
CFR 413.20 and 42 CFR 413.24; Use:
Providers of service in the Medicare
program are required to submit annual
information to achieve reimbursement
for health care services rendered to
Medicare beneficiaries. The Form CMS–
222 cost report is needed to determine
the amount of reasonable cost due to the
providers for furnishing medical
services to Medicare beneficiaries; Form
Number: CMS–222 (OMB# 0938–0107);
Frequency: Yearly; Affected Public:
Business or other for-profit and not-forprofit institutions; Number of
Respondents: 5,812; Total Annual
Responses: 5,812; Total Annual Hours:
290,600. (For policy questions regarding
this collection contact Steve A. Raitzyk
at 410–786–4599. For all other issues
call 410–786–1326.)
2. Type of Information Collection
Request: Extension without change of a
currently approved collection; Title of
Information Collection: Chain Home
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Office Cost Statement and supporting
Regulations in 42 CFR 413.17 and
413.20; Use: The Form CMS–287–05 is
filed annually by Chain Home Offices to
report the information necessary for the
determination of Medicare
reimbursement to components of chain
organizations. However, where
providers are components of chain
organizations, information included in
the chain home office cost statement is
in addition to that included in the
provider cost report and is needed to
determine whether payments are
appropriate. Form Number: CMS–287–
05 (OMB# 0938–0202); Frequency:
Yearly; Affected Public: Business or
other for-profit and not-for-profit
institutions; Number of Respondents:
1,541; Total Annual Responses: 1,541;
Total Annual Hours: 718,106. (For
policy questions regarding this
collection contact Nadia Massuda at
410–786–5834. For all other issues call
410–786–1326.)
3. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Attending
Physicians Statement and
Documentation of Medicare Emergency
and Supporting Regulations in 42 CFR
Section 424.103; Use: 42 CFR 424.103
(b) requires that before a
nonparticipating hospital may be paid
for emergency services rendered to a
Medicare beneficiary, a statement must
be submitted that is sufficiently
comprehensive to support that an
emergency existed. Form CMS–1771
contains a series of questions relating to
the medical necessity of the emergency.
The attending physician must attest that
the hospitalization was required under
the regulatory emergency definition (42
CFR 424.101) and give clinical
documentation to support the claim.
Form Number: CMS–1771 (OMB# 0938–
0023); Frequency: Yearly; Affected
Public: Private sector—Business or other
for-profit and not-for-profit institutions;
Number of Respondents: 100; Total
Annual Responses: 200; Total Annual
Hours: 50. (For policy questions
regarding this collection contact
Shauntari Cheely at 410–786–1818. For
all other issues call 410–786–1326.)
4. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Process and
Information Required To Determine
Eligibility of Drugs, Biologicals, and
Radiopharmaceutical Agents for
Transitional Pass-Through Status Under
the Hospital Outpatient Prospective
Payment System (OPPS); Use: Section
1833(t)(6) of the Social Security Act
provides for temporary additional
PO 00000
Frm 00043
Fmt 4703
Sfmt 4703
payments or ‘‘transitional pass-through
payments’’ for certain drugs and
biological agents. Interested parties such
as hospitals, pharmaceutical companies,
and physicians can apply for
transitional pass-through payment for
drugs and biologicals used with services
covered under the OPPS. CMS uses this
information to determine if the criteria
for making a transitional pass-through
payment are met and if an interim
Healthcare Common Procedure Coding
System (HCPCS) code for a new drug or
biological is necessary. Form Number:
CMS–10008 (OMB#: 0938–0802);
Frequency: Once; Affected Public:
Private sector—Business or other forprofit; Number of Respondents: 30;
Total Annual Responses: 480; Total
Annual Hours: 480. (For policy
questions regarding this collection
contact Christina Ritter Ph.D. at 410–
786–4636. 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 27, 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 20, 2011.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2011–13039 Filed 5–26–11; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Proposed Information Collection
Activity; Comment Request
Title: ACF–535 LIHEAP Quarterly
Allocation Estimates.
OMB No. 0970–0037.
Description: The LIHEAP Quarterly
Allocation Estimates, ACF Form-535 is
a one-page form that is sent to 50 State
grantees and to the District of Columbia.
It is also sent to Tribal Government
grantees that receive over $1 million
annually for the Low Income Home
Energy Assistance Program (LIHEAP).
Grantees are asked to complete and
submit the form in the 4th quarter of
each year. The data collected on the
form are grantees estimates of
obligations they expect to make each
E:\FR\FM\27MYN1.SGM
27MYN1
]]>Agencies
[Federal Register Volume 76, Number 103 (Friday, May 27, 2011)]
[Notices]
[Page 30944]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-13039]
[[Page 30944]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-222, CMS-287-05, CMS-1771, and CMS-10008]
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 currently
approved collection; Title of Information Collection: Independent Rural
Health Center/Freestanding Federally Qualified Health Center Cost
Report and Supporting Regulations 42 CFR 413.20 and 42 CFR 413.24; Use:
Providers of service in the Medicare program are required to submit
annual information to achieve reimbursement for health care services
rendered to Medicare beneficiaries. The Form CMS-222 cost report is
needed to determine the amount of reasonable cost due to the providers
for furnishing medical services to Medicare beneficiaries; Form Number:
CMS-222 (OMB 0938-0107); Frequency: Yearly; Affected Public:
Business or other for-profit and not-for-profit institutions; Number of
Respondents: 5,812; Total Annual Responses: 5,812; Total Annual Hours:
290,600. (For policy questions regarding this collection contact Steve
A. Raitzyk at 410-786-4599. For all other issues call 410-786-1326.)
2. Type of Information Collection Request: Extension without change
of a currently approved collection; Title of Information Collection:
Chain Home Office Cost Statement and supporting Regulations in 42 CFR
413.17 and 413.20; Use: The Form CMS-287-05 is filed annually by Chain
Home Offices to report the information necessary for the determination
of Medicare reimbursement to components of chain organizations.
However, where providers are components of chain organizations,
information included in the chain home office cost statement is in
addition to that included in the provider cost report and is needed to
determine whether payments are appropriate. Form Number: CMS-287-05
(OMB 0938-0202); Frequency: Yearly; Affected Public: Business
or other for-profit and not-for-profit institutions; Number of
Respondents: 1,541; Total Annual Responses: 1,541; Total Annual Hours:
718,106. (For policy questions regarding this collection contact Nadia
Massuda at 410-786-5834. For all other issues call 410-786-1326.)
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Attending
Physicians Statement and Documentation of Medicare Emergency and
Supporting Regulations in 42 CFR Section 424.103; Use: 42 CFR 424.103
(b) requires that before a nonparticipating hospital may be paid for
emergency services rendered to a Medicare beneficiary, a statement must
be submitted that is sufficiently comprehensive to support that an
emergency existed. Form CMS-1771 contains a series of questions
relating to the medical necessity of the emergency. The attending
physician must attest that the hospitalization was required under the
regulatory emergency definition (42 CFR 424.101) and give clinical
documentation to support the claim. Form Number: CMS-1771 (OMB
0938-0023); Frequency: Yearly; Affected Public: Private sector--
Business or other for-profit and not-for-profit institutions; Number of
Respondents: 100; Total Annual Responses: 200; Total Annual Hours: 50.
(For policy questions regarding this collection contact Shauntari
Cheely at 410-786-1818. For all other issues call 410-786-1326.)
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Process and
Information Required To Determine Eligibility of Drugs, Biologicals,
and Radiopharmaceutical Agents for Transitional Pass-Through Status
Under the Hospital Outpatient Prospective Payment System (OPPS); Use:
Section 1833(t)(6) of the Social Security Act provides for temporary
additional payments or ``transitional pass-through payments'' for
certain drugs and biological agents. Interested parties such as
hospitals, pharmaceutical companies, and physicians can apply for
transitional pass-through payment for drugs and biologicals used with
services covered under the OPPS. CMS uses this information to determine
if the criteria for making a transitional pass-through payment are met
and if an interim Healthcare Common Procedure Coding System (HCPCS)
code for a new drug or biological is necessary. Form Number: CMS-10008
(OMB: 0938-0802); Frequency: Once; Affected Public: Private
sector--Business or other for-profit; Number of Respondents: 30; Total
Annual Responses: 480; Total Annual Hours: 480. (For policy questions
regarding this collection contact Christina Ritter Ph.D. at 410-786-
4636. 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 27, 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 20, 2011.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. 2011-13039 Filed 5-26-11; 8:45 am]
BILLING CODE 4120-01-P
