Federal Register / Vol. 75, No. 199 / Friday, October 15, 2010 / Notices 63485 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–1561, CMS–R– 

308, CMS–10335 and CMS–R–53] 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, HHS. 

In compliance with the requirement 

of section 3506I(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 a currently 

approved collection; Title of 

Information Collection: Health 

Insurance Benefit Agreement; Use: 

Applicants to the Medicare program are 

required to agree to provide services in 

accordance with Federal requirements. 

The CMS–1561 is essential for CMS to 

ensure that applicants are in compliance 

with the requirements. Applicants will 

be required to sign the completed form 

and provide operational information to 

CMS to assure that they continue to 

meet the requirements after approval. 

Form Number: CMS–1561 (OMB#: 

0938–0832); Frequency: Yearly; Affected 

Public: Private Sector: Business or other 

for-profits and Not-for-profit 

institutions; Number of Respondents: 

3,000; Total Annual Responses: 3,000; 

Total Annual Hours: 500. (For policy 

questions regarding this collection 

contact JoAnn Perry at 410–786–3336. 

For all other issues call 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Children’s 

Health Insurance Program; Use: States 

are required to submit title XXI plans 

and amendments for approval by the 

Secretary pursuant to section 2102 of 

the Social Security Act in order to 

receive funds for initiating and 

expanding health insurance coverage for 

uninsured children. States are also 

required to submit State expenditure 

and statistical reports, annual reports 

and State evaluations to the Secretary as 

outlined in title XXI of the Social 

Security Act. Form Number: CMS–R– 

308 (OMB#: 0938–0841); Frequency: 

Yearly, Quarterly, Once and/or 

Occasionally; Affected Public: State, 

Local, or Tribal Governments; Number 

of Respondents: 56; Total Annual 

Responses: 1,114,124 Total Annual 

Hours: 864,973. (For policy questions 

regarding this collection contact Nancy 

Goetschius at 410–786–0707. For all 

other issues call 410–786–1326.) 410– 

786–1326.) 

3. Type of Information Collection 

Request: New collection; Title of 

Information Collection: Current State 

Practices Related to Payments to 

Providers for Health Care- Acquired 

Conditions; Use: The Patient Protection 

and Affordable Care Act of 2010 

(Affordable Care Act), enacted March 

23, 2010 includes provisions prohibiting 

Federal Financial Participation to States 

for payments for health care-acquired 

conditions (HCACs). Section 2702(a) 

specifically requires that the Secretary 

identify current State practices that 

prohibit payment for HCACs and 

incorporate those practices or elements 

of those practices which she determines 

appropriate for application to the 

Medicaid program. In accordance with 

section 2702(a) of the Affordable Care 

Act, CMS is issuing this survey to States 

to obtain information on current State 

Medicaid practices for prohibiting 

payments for HCACs. Form Number: 

CMS–10335 (OMB#: 0938–New); 

Frequency: Once; Affected Public: State, 

Local, or Tribal Governments; Number 

of Respondents: 50 Total Annual 

Responses: 50; Total Annual Hours: 50 

(For policy questions regarding this 

collection contact Venesa Day at 410– 

786–8281. For all other issues call 410– 

786–1326.) 

4. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Imposition of 

Cost Sharing Charges under Medicaid 

and Supporting Regulations in 42 CFR 

447.53; Use: The purpose of this 

collection is to ensure that States 

impose normal cost sharing charges 

upon categorically and medically needy 

individuals as allowed by law and 

implementing regulations. States must 

identify in their State plan the service 

for which the charge is made, the 

amount of the charge, the basis for 

determining the charge, the basis for 

determining whether an individual is 

unable to pay the charge and the way in 

which the individual will be identified 

to providers, and the procedures for 

implementing and enforcing the 

exclusions from cost sharing. Form 

Number: CMS–R–53 (OMB#: 0938– 

0429); Frequency: Occasionally; 

Affected Public: State, Local, or Tribal 

Governments; Number of Respondents: 

56; Total Annual Responses: 2; Total 

Annual Hours: 20. (For policy questions 

regarding this collection contact Barbara 

Washington at 410–786–9964. 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 

address at http://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 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 November 15, 2010. 

OMB, Office of Information and 

Regulatory Affairs, Attention: CMS Desk 

Officer, Fax Number: (202) 395–6974, Email: OIRA_submission@omb.eop.gov. 

Dated: October 8, 2010. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2010–25932 Filed 10–14–10; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Disease Control and 

Prevention 

[30Day–11–0728] 

Agency Forms Undergoing Paperwork 

Reduction Act Review 

The Centers for Disease Control and 

Prevention (CDC) publishes a list of 

information collection requests under 

review by the Office of Management and 

Budget (OMB) in compliance with the 

Paperwork Reduction Act (44 U.S.C. 

chapter 35). To request a copy of these 

requests, call the CDC Reports Clearance 

Officer at (404) 639–5960 or send an email to omb@cdc.gov. Send written 

comments to CDC Desk Officer, Office of 

Management and Budget, Washington, 

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