18222 Federal Register / Vol. 76, No. 63 / Friday, April 1, 2011 / Notices 

the State level. HHS must have such 

information in order to ascertain 

whether market destabilization has a 

high likelihood of occurring. Form 

Number: CMS–10361 (OMB Control No. 

0938–1114); Frequency: Once; Affected 

Public: State, local or tribal 

governments; Number of Respondents: 

20; Number of Responses: 20; Average 

Hours per Response: 185; Total Annual 

Hours: 3,700. (For policy questions 

regarding this collection, contact Carol 

Jimenez at (301) 492–4109. For all other 

issues regarding this collection, 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 at 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 May 31, 2011: 

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: March 28, 2011. 

Martique Jones, 

Director, Regulations Development Group, 

Division B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2011–7742 Filed 3–31–11; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–265–11, CMS– 

381, and CMS–10123 and 10124] 

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: Revision 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. The forms are 

revised in accordance with the EndStage Renal Disease Prospective 

Payment System Final Rule published 

August 12, 2010 which implemented 

statutory requirements of the Medicare 

Improvements for Patients and 

Providers Act (MIPPA), enacted July 15, 

2008. Additionally, the forms are 

revised to incorporate data previously 

reported on the Provider Cost Report 

Reimbursement Questionnaire, Form 

CMS–339. Form Number: CMS–265–94 

(OMB#: 0938–0236); Frequency: Yearly; 

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

Number of Respondents: 5,654 Total 

Annual Responses: 5,654; Total Annual 

Hours: 367,510 (For policy questions 

regarding this collection contact Gail 

Duncan at 410–786–7278. For all other 

issues call 410–786–1326.) 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Identification of 

Extension Units of Medicare Approved 

Outpatient Physical Therapy/Outpatient 

Speech Pathology (OPT/OSP) Providers 

and Supporting Regulations in 42 CFR 

485.701–485.729; Use: The collected 

information is used in conjunction with 

42 CFR 485.701 through 485.729 

governing the operation of providers of 

outpatient physical therapy and speechlanguage pathology services. The 

provider uses the form to report to the 

State survey agency extension locations 

that it has added since the date of last 

report. The form is used by the State 

survey agencies and by the CMS 

regional offices to identify and monitor 

extension locations to ensure their 

compliance with the Federal 

requirements for the providers of 

outpatient physical therapy and speechlanguage pathology services; Form 

Number: CMS–381 (OMB #: 0938– 

0273); Frequency: Annually; Affected 

Public: Private Sector; Business or other 

for-profit and not-for-profit institutions; 

Number of Respondents: 2,960; Total 

Annual Responses: 2,960; Total Annual 

Hours: 740. (For policy questions 

regarding this collection contact Georgia 

Johnson at 410–786–6859. For all other 

issues call 410–786–1326.) 

3. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Notice of 

Provider Non-Coverage (CMS–10123) 

and Detailed Explanation of NonCoverage (CMS–10124); Use: The Notice 

of Medicare Provider Non-Coverage 

(CMS–10123) is used to inform fee-forservice Medicare beneficiaries of the 

determination that their provider 

services will end, and of their right to 

an expedited review of that 

determination. The Detailed 

Explanation of Non-Coverage (CMS– 

10124) is used to provide beneficiaries 

who request an expedited determination 

with detailed information of why the 

services should end. The revised Notice 

of Provider Non-Coverage and Detailed 

Explanation of Provider Non-Coverage 

will no longer require use of the 

beneficiary’s Medicare number as a 

patient identifier. Instead, when 

applicable, providers may use a number 

that helps to link the notice with a 

related claim. Form Number: CMS– 

10123 and 10124 (OMB# 0938–0953); 

Frequency: Occasionally; Affected 

Public: Business or other for-profit, notfor-profit institutions, and Individuals 

or households; Number of Respondents: 

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Federal Register / Vol. 76, No. 63 / Friday, April 1, 2011 / Notices 18223 

5,314,164; Total Annual Responses: 

5,314,194; Total Annual Hours: 885,699. 

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 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 at 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 May 31, 2011: 

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: March 25, 2011. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2011–7746 Filed 3–31–11; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–R–148 and 

CMS–R–266] 

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 without change of a 

currently approved collection; Title of 

Information Collection: Limitations on 

Provider Related Donations and Health 

Care Related Taxes; Limitation on 

Payments for Disproportionate Share 

Hospitals and Supporting Regulations in 

42 CFR 433.68, 433.74 and 447.272; 

Use: The collected information 

collection is necessary to ensure 

compliance with sections 1903 and 

1923 of the Social Security Act by 

helping to prevent payments of Federal 

financial participation on amounts 

prohibited by statute; Form Number: 

CMS–R–148 (OMB#: 0938–0618); 

Frequency: Quarterly and occasionally; 

Affected Public: State, Local, or Tribal 

Governments; Number of Respondents: 

50; Total Annual Responses: 40; Total 

Annual Hours: 3,200. (For policy 

questions regarding this collection 

contact Rory Howe at 410–786–4878. 

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

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Medicaid 

Disproportionate Share Hospital Annual 

Reporting; Use: Section 1923(j)(i) of the 

Social Security Act (Act) requires States 

to submit an annual report that 

identifies each disproportionate share 

hospital (DSH) that received a DSH 

payment under the State’s Medicaid 

program in the preceding fiscal year and 

the amount of DSH payments paid to 

that hospital in the same year along 

with other information that the 

Secretary determines necessary to 

ensure the appropriateness of DSH 

payments. The collected information 

will also satisfy the requirements under 

section 1923(a)(2)(D) of the Act; Form 

Number: CMS–R–266 (OMB#: 0938– 

0746); Frequency: Yearly; Affected 

Public: State, Local, or Tribal 

Governments; Number of Respondents: 

52; Total Annual Responses: 52; Total 

Annual Hours: 1,976. (For policy 

questions regarding this collection 

contact Rory Howe at 410–786–4878. 

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 

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. 

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 May 2, 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: March 25, 2011. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2011–7747 Filed 3–31–11; 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: Descriptive Study of Early Head 

Start (Early Head Start Family and Child 

Experiences Study; Baby FACES). 

OMB No.: 0970–0354 

Description: The Administration for 

Children and Families (ACF), U.S. 

Department of Health and Human 

Services (HHS), anticipates continuing 

data collection for wave 4 of the parent 

interview, teacher child reports, care 

provider interviews and observations, 

direct child assessments, program 

director interviews, and family service 

tracking for the peri-natal cohort of the 

Descriptive Study of Early Head Start 

(Early Head Start Family and Child 

Experiences Study; Baby FACES). Data 

collection will continue for an 

additional 12 months beyond the 

current date of expiration (October 31, 

2011). 

This data collection is a part of Baby 

FACES, which is an important 

opportunity to provide a description of 

the characteristics, experiences, and 

outcomes of Early Head Start children 

and families, and Early Head Start 

Program services and delivery. All of 

the information obtained will be used to 

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