30030 Federal Register / Vol. 75, No. 103 / Friday, May 28, 2010 / Notices 

bank holding companies may be 

obtained from the National Information 

Center website at www.ffiec.gov/nic/. 

Unless otherwise noted, comments 

regarding the applications must be 

received at the Reserve Bank indicated 

or the offices of the Board of Governors 

not later than June 15, 2010. 

A. Federal Reserve Bank of Chicago 

(Colette A. Fried, Assistant Vice 

President) 230 South LaSalle Street, 

Chicago, Illinois 60690–1414: 

1. NC Bancorp, Inc., Chicago, Illinois; 

to continue to engage de novo in 

making, acquiring, brokering or 

servicing loans or other extensions of 

credit, pursuant to section 225.28(b)(1) 

of Regulation Y. 

B. Federal Reserve Bank of San 

Francisco (Kenneth Binning, Vice 

President, Applications and 

Enforcement) 101 Market Street, San 

Francisco, California 94105–1579: 

1. Mission Community Bancorp, San 

Luis Obispo, California; Carpenter Fund 

Manager GP, LLC; Carpenter Fund 

Management, LLC; Carpenter 

Community Bancfund, L.P.; Carpenter 

Community Bancfund–A, L.P.; 

Carpenter Community Bancfund–CA, 

L.P.; CCFW, Inc.; and SCJ, Inc., all of 

Irvine, California; to acquire Mission 

Asset Management, Inc., San Luis 

Obispo, California, and thereby egnage 

in extending credit and servicing loans, 

pursuant to section 225.28(b)(1) of 

Regulation Y. 

Board of Governors of the Federal Reserve 

System, May 25, 2010. 

Robert deV. Frierson, 

Deputy Secretary of the Board. 

[FR Doc. 2010–12913 Filed 5–27–10; 8:45 am] 

BILLING CODE 6210–01–S 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10314, CMS– 

264–94, CMS–1728–94, CMS–10240 and 

CMS–P–0015A] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services. 

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: New collection; Title of 

Information Collection: Medicare 

Savings Program Protection from 

Medicaid Estate Recovery—State Plan 

Pre-print under Title XIX. Form No: 

CMS–10314 (OMB# 0938–New); Use: 

Section 115 of the Medicare 

Improvements for Patients and 

Providers Act (MIPPA)—2008, provides 

new protections from Medicaid estate 

recovery for limited categories of dual 

eligibles age 55 and over. To offer these 

protections, States have to amend their 

Medicaid State plans to reflect these 

new limits on estate recovery. To reduce 

paperwork burden and expedite this 

process, CMS is providing States with a 

pre-printed document (i.e., a State plan 

preprint) which neither needs nor 

requires any insertion of language or 

even completion of a check-off box. As 

Section 115 simply mandates 

compliance (there is no option not to 

comply), States only need return the 

preprint page (as prepared by CMS) to 

CMS, as a requested amendment to their 

State Plan. This is a one-time only 

submission, with little burden 

imposition and complete electronic 

routing to and from States. Frequency: 

Reporting—Once; Affected Public: State, 

Local or Tribal Governments; Number of 

Respondents: 51; Total Annual 

Responses: 51; Total Annual Hours: 

102. (For policy questions regarding this 

collection contact Nancy Dieter at 410– 

786–7219. For all other issues call 410– 

786–1326.) 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Independent 

Renal Dialysis Facility Cost Report; Use: 

The Independent Renal Dialysis Facility 

Cost Report, is filed annually by 

providers participating in the Medicare 

program to identify the specific items of 

cost and statistics of facility operation 

that independent renal dialysis facilities 

are required to report. Form Number: 

CMS–265–94 (OMB#: 0938–0236); 

Frequency: Yearly; Affected Public: 

Business or other for-profits and Notfor-profit institutions; Number of 

Respondents: 5,508; Total Annual 

Responses: 5,508; Total Annual Hours: 

275,400. (For policy questions regarding 

this collection contact Gail Duncan at 

410–786–7278. For all other issues call 

410–786–1326.) 

3. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Home Health 

Agency Cost Report; Use: These cost 

report forms are filed annually by 

freestanding providers participating in 

the Medicare program to effect year end 

cost settlement for providing services to 

Medicare beneficiaries. The data 

submitted on the cost reports supports 

management of Federal programs. 

Providers receiving Medicare 

reimbursement must provide adequate 

cost data based on financial and 

statistical records which can be verified 

by qualified auditors. The data from 

these cost reporting forms will be used 

for the purpose of evaluating current 

levels of Medicare reimbursement. Form 

Number: CMS–1728–94 (OMB#: 0938– 

0022); Frequency: Yearly; Affected 

Public: Business or other for-profits and 

Not-for-profit institutions; Number of 

Respondents: 7,479; Total Annual 

Responses: 7,479; Total Annual Hours: 

1,690,254. (For policy questions 

regarding this collection contact Angela 

Havrilla at 410–786–4516. For all other 

issues call 410–786–1326.) 

4. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Data Collection 

for the Nursing Home Value-Based 

Purchasing (NHVBP) Demonstration; 

Use: The goal of the NHVBP 

Demonstration is to use financial 

incentives to improve the quality of care 

in nursing homes. The main purpose of 

the NHVBP data collection effort is to 

gather information that will enable CMS 

to determine which nursing homes will 

be eligible to receive incentive 

payments under the NHVBP 

Demonstration. Information will be 

collected from nursing homes 

participating in the demonstration on an 

ongoing basis. CMS will collect payrollbased staffing, agency staffing and 

resident census information to help 

assess the quality of care in 

participating nursing homes. CMS will 

determine which homes qualify for an 

incentive payment based on their 

relative performance in terms of quality. 

Form Number: CMS–10240 (OMB#: 

0938–1039); Frequency: Quarterly; 

Affected Public: Business or other forprofits and Not-for-profit institutions; 

Number of Respondents: 178; Total 

Annual Responses: 712; Total Annual 


jlentini on DSKJ8SOYB1PROD with NOTICES
Federal Register / Vol. 75, No. 103 / Friday, May 28, 2010 / Notices 30031 

Hours: 5,530. (For policy questions 

regarding this collection contact Ron 

Lambert at 410–786–6624. For all other 

issues call 410–786–1326.) 

5. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Medicare 

Current Beneficiary Survey; Use: The 

Medicare Current Beneficiary Survey 

(MCBS) serves to measure what impact 

the changes have on the program and its 

beneficiaries. The MCBS is a 

comprehensive data collection effort 

that fills an information gap in the 

Centers for Medicare and Medicaid 

Services, and is depended on to help 

manage the program. Being able to 

examine various characteristics and to 

chart evolving trends offers policy 

makers a reliable tool for making 

informed decisions. The MCBS is used 

to identify potential new policy 

direction or modifications to the 

Medicare program and once those 

program enhancements are 

implemented, monitor the impact of 

those changes. The central goals of the 

MCBS are to determine medical care 

expenditures and sources of payment 

for all services, including copayments, 

deductibles, and non-covered services; 

to ascertain all types of health insurance 

coverage and relate coverage to actual 

payments; and to trace processes over 

time, such as changes in health status, 

spending down to Medicaid eligibility, 

and the impacts of program changes. 

Form Number: CMS–P–0015A (OMB#: 

0938–0568); Frequency: Yearly; Affected 

Public: Business or other for-profits and 

Not-for-profit institutions; Number of 

Respondents: 16,217; Total Annual 

Responses: 48,650; Total Annual Hours: 

57,062. (For policy questions regarding 

this collection contact William Long at 

410–786–7927. 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 http://www.cms.hhs.gov/ 

PaperworkReductionActof1995, 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 on (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 27, 2010: 

1. Electronically. You may submit 

your comments electronically to http:// 

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 21, 2010. 

Martique Jones, 

Director, Regulations Development DivisionB, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2010–12624 Filed 5–27–10; 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 

Proposed Projects 

Title: Child Care and Development 

Block Grant Reporting Requirements— 

ACF–700. 

OMB No.: 0980–0241. 

Description: The Child Care and 

Development Fund (CCDF) report 

requests annual Tribal aggregate 

information on services provided 

through the CCDF, which is required by 

the CCDF Final Rule (45 FR parts 98 and 

99). Tribal Lead Agencies (TLAs) are 

required to submit annual aggregate data 

appropriate to Tribal programs on 

children and families receiving CCDFfunded child care services. The CCDF 

statute and regulations also require 

TLAs to submit a supplemental 

narrative as part of the ACF–700 report. 

This narrative describes child care 

activities and actions in the TLA’s 

service area. Information from the ACF– 

700 and supplemental narrative report 

will be included in the Secretary’s 

Report to Congress, as appropriate, and 

will be shared with all TLAs to inform 

them of CCDF-funded activities in other 

Tribal programs. 

Respondents: Tribal Governments. 

ANNUAL BURDEN ESTIMATES

Instrument Number of 

respondents 

Number of 

responses 

per respondent 

Average 

burden hours 

per response 

Total burden 

hours 

ACF–700 Report .............................................................................................. 260 1 38 9,880 

Estimated Total Annual Burden 

Hours: 9,880. 

In compliance with the requirements 

of Section 506(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 


jlentini on DSKJ8SOYB1PROD with NOTICES