Proposed Information Collection Activity; Comment Request, 30944-30945 [2011-13216]
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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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AGENCY:
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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
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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
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Federal Register / Vol. 76, No. 103 / Friday, May 27, 2011 / Notices
quarter for the upcoming fiscal year for
the LIHEAP program. This is the only
method used to request anticipated
distributions of the grantees LIHEAP
funds. The information is used to
develop apportionment requests to OMB
and to make grant awards based on
grantees anticipated needs. Information
collected on this form is not available
through any other Federal source.
Submission of the form is voluntary.
Respondents: State Governments,
Tribal Governments that receive over $1
million annually, and the District of
Columbia.
ANNUAL BURDEN ESTIMATES
Instrument
Number of
respondents
Number of
responses per
respondent
Average
burden hours
per response
Total burden
hours
LIHEAP Quarterly Allocation Estimates, ACF–535 .........................................
55
1
0.25
13.75
Estimated Total Annual Burden
Hours: 13.75
In compliance with the requirements
of Section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the
Administration for Children and
Families is soliciting public comment
on the specific aspects of the
information collection described above.
Copies of the proposed collection of
information can be obtained and
comments may be forwarded by writing
to the Administration for Children and
Families, Office of Administration,
Office of Information Services, 370
L’Enfant Promenade, SW., Washington,
DC 20447, Attn: ACF Reports Clearance
Officer. E-mail address:
infocollection@acf.hhs.gov. All requests
should be identified by the title of the
information collection.
The Department specifically requests
comments on: (a) Whether the proposed
collection of information is necessary
for the proper performance of the
functions of the agency, including
whether the information shall have
practical utility; (b) the accuracy of the
agency’s estimate of the burden of the
proposed collection of information; (c)
the quality, utility, and clarity of the
information to be collected; and (d)
ways to minimize the burden of the
collection of information on
respondents, including through the use
of automated collection techniques or
other forms of information technology.
Consideration will be given to
comments and suggestions submitted
within 60 days of this publication.
Robert Sargis,
Reports Clearance Officer.
[FR Doc. 2011–13216 Filed 5–26–11; 8:45 am]
BILLING CODE 4184–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Submission for OMB Review;
Comment Request
OMB No.: 0980–0162.
Description: A Plan developed by the
State Council on Developmental
Disabilities is required by federal
statute. Each State Council on
Developmental Disabilities must
develop the plan, provide for approval
by the State Governor, and finally
submit the plan on a five-year basis. On
an annual basis, the Council must
review the plan and make any
amendments. The State Plan will be
used (1) By the Council as a planning
document; (2) by the citizenry of the
State as a mechanism for commenting
on the plans of the Council; and (3) by
the Department as a stewardship tool,
for ensuring compliance with the
Developmental Disabilities Assistance
and Bill of Rights Act, as one basis for
providing technical assistance (e.g.,
during site visits), and as a support for
management decision making.
Respondents: 55 State Developmental
Disabilities Councils.
Title: State Developmental Disabilities
Council 5-Year State Plan.
ANNUAL BURDEN ESTIMATES
Number of
responses per
respondent
Number of
respondents
Instrument
Average burden
hours per
response
Total burden
hours
55
1
367
20,185
Estimated Total Annual Burden Hours .....................................
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State Developmental Disabilities Council 5-Year State Plan ..........
............................
............................
............................
20,185
Additional Information:
Copies of the proposed collection may
be obtained by writing to the
Administration for Children and
Families, Office of Administration,
Office of Information Services, 370
L’Enfant Promenade, SW., Washington,
DC 20447, Attn: ACF Reports Clearance
Officer. All requests should be
identified by the title of the information
collection. E-mail address:
infocollection@acf.hhs.gov.
OMB Comment:
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OMB is required to make a decision
concerning the collection of information
between 30 and 60 days after
publication of this document in the
Federal Register. Therefore, a comment
is best assured of having its full effect
if OMB receives it 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: 202–395–7285,
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E-mail:
OIRA_SUBMISSION@OMB.EOP.GOV
Attn: Desk Officer for the
Administration for Children and
Families.
Robert Sargis,
Reports Clearance Officer.
[FR Doc. 2011–13259 Filed 5–26–11; 8:45 am]
BILLING CODE 4184–01–P
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[Federal Register Volume 76, Number 103 (Friday, May 27, 2011)]
[Notices]
[Pages 30944-30945]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-13216]
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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
[[Page 30945]]
quarter for the upcoming fiscal year for the LIHEAP program. This is
the only method used to request anticipated distributions of the
grantees LIHEAP funds. The information is used to develop apportionment
requests to OMB and to make grant awards based on grantees anticipated
needs. Information collected on this form is not available through any
other Federal source. Submission of the form is voluntary.
Respondents: State Governments, Tribal Governments that receive
over $1 million annually, and the District of Columbia.
ANNUAL BURDEN ESTIMATES
----------------------------------------------------------------------------------------------------------------
Number of Average burden
Instrument Number of responses per hours per Total burden
respondents respondent response hours
----------------------------------------------------------------------------------------------------------------
LIHEAP Quarterly Allocation Estimates, ACF- 55 1 0.25 13.75
535........................................
----------------------------------------------------------------------------------------------------------------
Estimated Total Annual Burden Hours: 13.75
In compliance with the requirements of Section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the Administration for Children and
Families is soliciting public comment on the specific aspects of the
information collection described above. Copies of the proposed
collection of information can be obtained and comments may be forwarded
by writing to the Administration for Children and Families, Office of
Administration, Office of Information Services, 370 L'Enfant Promenade,
SW., Washington, DC 20447, Attn: ACF Reports Clearance Officer. E-mail
address: infocollection@acf.hhs.gov. All requests should be identified
by the title of the information collection.
The Department specifically requests comments on: (a) Whether the
proposed collection of information is necessary for the proper
performance of the functions of the agency, including whether the
information shall have practical utility; (b) the accuracy of the
agency's estimate of the burden of the proposed collection of
information; (c) the quality, utility, and clarity of the information
to be collected; and (d) ways to minimize the burden of the collection
of information on respondents, including through the use of automated
collection techniques or other forms of information technology.
Consideration will be given to comments and suggestions submitted
within 60 days of this publication.
Robert Sargis,
Reports Clearance Officer.
[FR Doc. 2011-13216 Filed 5-26-11; 8:45 am]
BILLING CODE 4184-01-P
