Agency Information Collection Activities: Submission for OMB Review; Comment Request, 12903-12904 [2016-05472]
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12903
Federal Register / Vol. 81, No. 48 / Friday, March 11, 2016 / Notices
ESTIMATED ANNUALIZED BURDEN HOURS
Average
burden per
response
(in hrs.)
Number of
responses per
respondent
Number of
respondents
Total burden
(in hrs.)
Type of respondents
Form name
Adult at least 18 years old using a
private well for tap water.
Screening Form ................................
Questionnaire ...................................
Urine Specimen and Tap Water
Sample Collection.
2,500
2,000
2,000
1
1
1
6/60
35/60
20/60
250
1,167
667
Total ...........................................
...........................................................
........................
........................
........................
2,084
Leroy A. Richardson,
Chief, Information Collection Review Office,
Office of Scientific Integrity, Office of the
Associate Director for Science, Office of the
Director, Centers for Disease Control and
Prevention.
[FR Doc. 2016–05519 Filed 3–10–16; 8:45 am]
BILLING CODE 4163–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifiers: CMS–359/360, CMS–
10003, and CMS–10280]
Agency Information Collection
Activities: Submission for OMB
Review; Comment Request
ACTION:
Notice.
The Centers for Medicare &
Medicaid Services (CMS) is announcing
an opportunity for the public to
comment on CMS’ intention to collect
information from the public. Under the
Paperwork Reduction Act of 1995
(PRA), federal agencies are required to
publish notice in the Federal Register
concerning each proposed collection of
information, including each proposed
extension or reinstatement of an existing
collection of information, and to allow
a second opportunity for public
comment on the notice. Interested
persons are invited to send comments
regarding the burden estimate or any
other aspect of this collection of
information, including any of the
following subjects: The necessity and
utility of the proposed information
collection for the proper performance of
the agency’s functions; the accuracy of
the estimated burden; ways to enhance
the quality, utility, and clarity of the
information to be collected; and the use
of automated collection techniques or
other forms of information technology to
minimize the information collection
burden.
asabaliauskas on DSK3SPTVN1PROD with NOTICES
SUMMARY:
VerDate Sep<11>2014
17:56 Mar 10, 2016
Jkt 238001
Comments on the collection(s) of
information must be received by the
OMB desk officer by April 11, 2016.
ADDRESSES: When commenting on the
proposed information collections,
please reference the document identifier
or OMB control number. To be assured
consideration, comments and
recommendations must be received by
the OMB desk officer via one of the
following transmissions: OMB, Office of
Information and Regulatory Affairs,
Attention: CMS Desk Officer, Fax
Number: (202) 395–5806 OR Email:
OIRA_submission@omb.eop.gov.
To obtain copies of a supporting
statement and any related forms for the
proposed collection(s) summarized in
this notice, you may make your request
using one of following:
1. Access CMS’ Web site address at
https://www.cms.hhs.gov/Paperwork
ReductionActof1995.
2. Email your request, including your
address, phone number, OMB number,
and CMS document identifier, to
Paperwork@cms.hhs.gov.
3. Call the Reports Clearance Office at
(410) 786–1326.
FOR FURTHER INFORMATION CONTACT:
Reports Clearance Office at (410) 786–
1326.
SUPPLEMENTARY INFORMATION: Under the
Paperwork Reduction Act of 1995 (PRA)
(44 U.S.C. 3501–3520), federal agencies
must obtain approval from the Office of
Management and Budget (OMB) for each
collection of information they conduct
or sponsor. The term ‘‘collection of
information’’ is defined in 44 U.S.C.
3502(3) and 5 CFR 1320.3(c) and
includes agency requests or
requirements that members of the public
submit reports, keep records, or provide
information to a third party. Section
3506(c)(2)(A) of the PRA (44 U.S.C.
3506(c)(2)(A)) requires federal agencies
to publish a 30-day notice in the
Federal Register concerning each
proposed collection of information,
including each proposed extension or
reinstatement of an existing collection
of information, before submitting the
collection to OMB for approval. To
DATES:
PO 00000
Frm 00046
Fmt 4703
Sfmt 4703
comply with this requirement, CMS is
publishing this notice that summarizes
the following proposed collection(s) of
information for public comment:
1. Type of Information Collection
Request: Extension of a currently
approved information collection; Title
of Information Collection:
Comprehensive Outpatient
Rehabilitation Facility (CORF)
Eligibility and Survey Forms and
Supporting Regulations; Use: The form
CMS–359 is used as the application for
health care providers seeking to
participate in the Medicare program as
a Comprehensive Outpatient
Rehabilitation Facility (CORF). This
form initiates the process for facilities to
become certified as a CORF and it
provides the CMS Regional Office State
Survey Agency staff identifying
information regarding the applicant that
is stored in the Automated Survey
Processing Environment (ASPEN)
system.
The form CMS–360 is a survey tool
used by the State Survey Agencies to
record information in order to
determine a provider’s compliance with
the CORF Conditions of Participation
(CoPs) and to report this information to
the Federal government. The form
includes basic information on the CoP
requirements, check boxes to indicate
the level of compliance, and a section
for recording notes. We have the
responsibility and authority for
certification decisions which are based
on provider compliance with the CoPs
and this form supports this process.
Form Number: CMS–359/360 (OMB
control number: 0938–0267); Frequency:
Occasionally; Affected Public: Private
Sector (Business or other for-profits);
Number of Respondents: 50; Number of
Responses: 50; Total Annual Hours:
123. (For questions regarding this
collection contact James Cowher (410)
786–1948.)
2. Type of Information Collection
Request: Revision of a currently
approved collection; Title of
Information Collection: Notice of Denial
of Medical Coverage (or Payment); Use:
Medicare health plans, including
E:\FR\FM\11MRN1.SGM
11MRN1
asabaliauskas on DSK3SPTVN1PROD with NOTICES
12904
Federal Register / Vol. 81, No. 48 / Friday, March 11, 2016 / Notices
Medicare Advantage plans, cost plans,
and Health Care Prepayment Plans, are
required to issue the CMS–10003 form
when a request for either a medical
service or payment is denied in whole
or in part. The notice explains why the
plan denied the service or payment and
informs Medicare enrollees of their
appeal rights. The notice is also used, as
appropriate, to explain Medicaid appeal
rights to full dual eligible individuals
enrolled in a Medicare health plan that
is also managing the individual’s
Medicaid benefits. The PRA package has
been revised subsequent to the
publication of the 60-day Federal
Register notice (October 16, 2015; 80 FR
62534). Form Number: CMS–10003
(OMB control number: 0938–0829).
Frequency: Occasionally; Affected
Public: Private sector (Business or other
for-profit and Not-for-profit
institutions); Number of Respondents:
730; Total Annual Responses:
33,574,293; Total Annual Hours:
5,593,477. (For policy questions
regarding this collection contact Staci
Paige at 410–786–2045.)
3. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Home Health
Change of Care Notice (HHCCN); Use:
The Home Health Change of Care Notice
(HHCCN) is used to notify original
Medicare beneficiaries receiving home
health care benefits of plan of care
changes. Home health agencies (HHAs)
must provide the HHCCN whenever
they reduce or terminate a beneficiary’s
home health services due to physician/
provider orders or limitation of the HHA
in providing the specific service.
Notification is required for covered and
non-covered services listed in the plan
of care. This iteration contains nonsubstantive changes which add language
informing beneficiaries of their rights
under Section 504 of the Rehabilitation
Act of 1973 by alerting the beneficiary
to CMS’ nondiscrimination practices
and the availability of alternate forms of
this notice if needed. There are no
substantive changes. Form Number:
CMS–10280 (OMB control number:
0938–0829); Frequency: Occasionally;
Affected Public: Private sector (Business
or other for-profits and Not-for-profit
institutions); Number of Respondents:
12,459; Total Annual Responses:
13,764,434; Total Annual Hours:
917,262. (For policy questions regarding
this collection contact Evelyn Blaemire
at 410–786–1803).
VerDate Sep<11>2014
17:56 Mar 10, 2016
Jkt 238001
Dated: March 7, 2016.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office
of Strategic Operations and Regulatory
Affairs.
[FR Doc. 2016–05472 Filed 3–10–16; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–10146, CMS–
10377, CMS–10465 and CMS–10409]
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Centers for Medicare &
Medicaid Services, HHS.
ACTION: Notice.
AGENCY:
The Centers for Medicare &
Medicaid Services (CMS) is announcing
an opportunity for the public to
comment on CMS’ intention to collect
information from the public. Under the
Paperwork Reduction Act of 1995 (the
PRA), federal agencies are required to
publish notice in the Federal Register
concerning each proposed collection of
information (including each proposed
extension or reinstatement of an existing
collection of information) and to allow
60 days for public comment on the
proposed action. Interested persons are
invited to send comments regarding our
burden estimates or any other aspect of
this collection of information, including
any of the following subjects: The
necessity and utility of the proposed
information collection for the proper
performance of the agency’s functions;
the accuracy of the estimated burden;
ways to enhance the quality, utility, and
clarity of the information to be
collected; and the use of automated
collection techniques or other forms of
information technology to minimize the
information collection burden.
DATES: Comments must be received by
May 10, 2016.
ADDRESSES: When commenting, please
reference the document identifier or
OMB control number. To be assured
consideration, comments and
recommendations must be submitted in
any one of the following ways:
1. Electronically. You may send 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) that are accepting
comments.
SUMMARY:
PO 00000
Frm 00047
Fmt 4703
Sfmt 4703
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 lll, Room C4–26–
05, 7500 Security Boulevard, Baltimore,
Maryland 21244–1850.
To obtain copies of a supporting
statement and any related forms for the
proposed collection(s) summarized in
this notice, you may make your request
using one of following:
1. Access CMS’ Web site address at
https://www.cms.hhs.gov/
PaperworkReductionActof1995.
2. Email your request, including your
address, phone number, OMB number,
and CMS document identifier, to
Paperwork@cms.hhs.gov.
3. Call the Reports Clearance Office at
(410) 786–1326.
FOR FURTHER INFORMATION CONTACT:
Reports Clearance Office at (410) 786–
1326.
SUPPLEMENTARY INFORMATION:
Contents
This notice sets out a summary of the
use and burden associated with the
following information collections. More
detailed information can be found in
each collection’s supporting statement
and associated materials (see
ADDRESSES).
CMS–10146 Notice of Denial of
Medicare Prescription Drug Coverage
CMS–10377 Student Health Insurance
Coverage
CMS–10465 Minimum Essential
Coverage
CMS–10409 Long Term Care Hospital
(LCTH) Continuity Assessment
Record and Evaluation (CARE) Data
Set
Under the PRA (44 U.S.C. 3501–
3520), federal agencies must obtain
approval from the Office of Management
and Budget (OMB) for each collection of
information they conduct or sponsor.
The term ‘‘collection of information’’ is
defined in 44 U.S.C. 3502(3) and 5 CFR
1320.3(c) and includes agency requests
or requirements that members of the
public submit reports, keep records, or
provide information to a third party.
Section 3506(c)(2)(A) of the PRA
requires federal agencies to publish a
60-day notice in the Federal Register
concerning each proposed collection of
information, including each proposed
extension or reinstatement of an existing
collection of information, before
submitting the collection to OMB for
approval. To comply with this
requirement, CMS is publishing this
notice.
E:\FR\FM\11MRN1.SGM
11MRN1
]]>Agencies
[Federal Register Volume 81, Number 48 (Friday, March 11, 2016)]
[Notices]
[Pages 12903-12904]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-05472]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifiers: CMS-359/360, CMS-10003, and CMS-10280]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: The Centers for Medicare & Medicaid Services (CMS) is
announcing an opportunity for the public to comment on CMS' intention
to collect information from the public. Under the Paperwork Reduction
Act of 1995 (PRA), federal agencies are required to publish notice in
the Federal Register concerning each proposed collection of
information, including each proposed extension or reinstatement of an
existing collection of information, and to allow a second opportunity
for public comment on the notice. Interested persons are invited to
send comments regarding the burden estimate or any other aspect of this
collection of information, including any of the following subjects: The
necessity and utility of the proposed information collection for the
proper performance of the agency's functions; the accuracy of the
estimated burden; ways to enhance the quality, utility, and clarity of
the information to be collected; and the use of automated collection
techniques or other forms of information technology to minimize the
information collection burden.
DATES: Comments on the collection(s) of information must be received by
the OMB desk officer by April 11, 2016.
ADDRESSES: When commenting on the proposed information collections,
please reference the document identifier or OMB control number. To be
assured consideration, comments and recommendations must be received by
the OMB desk officer via one of the following transmissions: OMB,
Office of Information and Regulatory Affairs, Attention: CMS Desk
Officer, Fax Number: (202) 395-5806 OR Email:
OIRA_submission@omb.eop.gov.
To obtain copies of a supporting statement and any related forms
for the proposed collection(s) summarized in this notice, you may make
your request using one of following:
1. Access CMS' Web site address at https://www.cms.hhs.gov/PaperworkReductionActof1995.
2. Email your request, including your address, phone number, OMB
number, and CMS document identifier, to Paperwork@cms.hhs.gov.
3. Call the Reports Clearance Office at (410) 786-1326.
FOR FURTHER INFORMATION CONTACT: Reports Clearance Office at (410) 786-
1326.
SUPPLEMENTARY INFORMATION: Under the Paperwork Reduction Act of 1995
(PRA) (44 U.S.C. 3501-3520), federal agencies must obtain approval from
the Office of Management and Budget (OMB) for each collection of
information they conduct or sponsor. The term ``collection of
information'' is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and
includes agency requests or requirements that members of the public
submit reports, keep records, or provide information to a third party.
Section 3506(c)(2)(A) of the PRA (44 U.S.C. 3506(c)(2)(A)) requires
federal agencies to publish a 30-day notice in the Federal Register
concerning each proposed collection of information, including each
proposed extension or reinstatement of an existing collection of
information, before submitting the collection to OMB for approval. To
comply with this requirement, CMS is publishing this notice that
summarizes the following proposed collection(s) of information for
public comment:
1. Type of Information Collection Request: Extension of a currently
approved information collection; Title of Information Collection:
Comprehensive Outpatient Rehabilitation Facility (CORF) Eligibility and
Survey Forms and Supporting Regulations; Use: The form CMS-359 is used
as the application for health care providers seeking to participate in
the Medicare program as a Comprehensive Outpatient Rehabilitation
Facility (CORF). This form initiates the process for facilities to
become certified as a CORF and it provides the CMS Regional Office
State Survey Agency staff identifying information regarding the
applicant that is stored in the Automated Survey Processing Environment
(ASPEN) system.
The form CMS-360 is a survey tool used by the State Survey Agencies
to record information in order to determine a provider's compliance
with the CORF Conditions of Participation (CoPs) and to report this
information to the Federal government. The form includes basic
information on the CoP requirements, check boxes to indicate the level
of compliance, and a section for recording notes. We have the
responsibility and authority for certification decisions which are
based on provider compliance with the CoPs and this form supports this
process. Form Number: CMS-359/360 (OMB control number: 0938-0267);
Frequency: Occasionally; Affected Public: Private Sector (Business or
other for-profits); Number of Respondents: 50; Number of Responses: 50;
Total Annual Hours: 123. (For questions regarding this collection
contact James Cowher (410) 786-1948.)
2. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Notice of Denial
of Medical Coverage (or Payment); Use: Medicare health plans, including
[[Page 12904]]
Medicare Advantage plans, cost plans, and Health Care Prepayment Plans,
are required to issue the CMS-10003 form when a request for either a
medical service or payment is denied in whole or in part. The notice
explains why the plan denied the service or payment and informs
Medicare enrollees of their appeal rights. The notice is also used, as
appropriate, to explain Medicaid appeal rights to full dual eligible
individuals enrolled in a Medicare health plan that is also managing
the individual's Medicaid benefits. The PRA package has been revised
subsequent to the publication of the 60-day Federal Register notice
(October 16, 2015; 80 FR 62534). Form Number: CMS-10003 (OMB control
number: 0938-0829). Frequency: Occasionally; Affected Public: Private
sector (Business or other for-profit and Not-for-profit institutions);
Number of Respondents: 730; Total Annual Responses: 33,574,293; Total
Annual Hours: 5,593,477. (For policy questions regarding this
collection contact Staci Paige at 410-786-2045.)
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Home Health
Change of Care Notice (HHCCN); Use: The Home Health Change of Care
Notice (HHCCN) is used to notify original Medicare beneficiaries
receiving home health care benefits of plan of care changes. Home
health agencies (HHAs) must provide the HHCCN whenever they reduce or
terminate a beneficiary's home health services due to physician/
provider orders or limitation of the HHA in providing the specific
service. Notification is required for covered and non-covered services
listed in the plan of care. This iteration contains non-substantive
changes which add language informing beneficiaries of their rights
under Section 504 of the Rehabilitation Act of 1973 by alerting the
beneficiary to CMS' nondiscrimination practices and the availability of
alternate forms of this notice if needed. There are no substantive
changes. Form Number: CMS-10280 (OMB control number: 0938-0829);
Frequency: Occasionally; Affected Public: Private sector (Business or
other for-profits and Not-for-profit institutions); Number of
Respondents: 12,459; Total Annual Responses: 13,764,434; Total Annual
Hours: 917,262. (For policy questions regarding this collection contact
Evelyn Blaemire at 410-786-1803).
Dated: March 7, 2016.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2016-05472 Filed 3-10-16; 8:45 am]
BILLING CODE 4120-01-P
