19776 Federal Register / Vol. 76, No. 68 / Friday, April 8, 2011 / Notices 

Clinical and Operational Performance 

(DCOP) within the Medicare Drug 

Benefit Group. Form Number: CMS– 

10185 (OMB#: 0938–0992); Frequency: 

Yearly, Quarterly, Semi-Annually; 

Affected Public: Private Sector, business 

or other for-profit; Number of 

Respondents: 2993; Total Annual 

Responses: 48,490; Total Annual Hours: 

128,754. (For policy questions regarding 

this collection contact LaToyia Grant at 

410–786–5434. For all other issues call 

410–786–1326.) 

2. Type of Information Collection 

Request: Revision of currently approved 

collection; Title of Information 

Collection: Part C Medicare Advantage 

(MA) Reporting Requirements and 

Supporting Regulations; Use: CMS has 

authority to establish reporting 

requirements for Medicare Advantage 

Organizations (MAO’s) as described in 

42 CFR 422.516(a). Each MAO must 

have an effective procedure to develop, 

compile, evaluate, and report to CMS, to 

its enrollees, and to the general public, 

at the times and in the manner that CMS 

requires, and while safeguarding the 

confidentiality of the doctor-patient 

relationship, statistics and other 

information with respect to the cost of 

its operations, patterns of service 

utilization, availability, accessibility, 

and acceptability of its services, 

developments in the health status of its 

enrollees, and other matters that CMS 

may require. Data collected via 

Medicare Part C Reporting 

Requirements will be an integral 

resource for oversight, monitoring, 

compliance and auditing activities 

necessary to ensure quality provision of 

the benefits provided by MA plans to 

enrollees. Form Number: CMS–10261 

(OMB# 0938–1054); Frequency: Yearly, 

Quarterly; Affected Public: Business or 

other for-profits; Number of 

Respondents: 588; Total Annual 

Responses: 1158; Total Annual Hours: 

245,528. (For policy questions regarding 

this collection contact Terry Leid at 

410–786–8973. For all other issues call 

410–786–1326.) 

3. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: CMS Survey 

Tool for http://www.cms.gov and 

http://www.medicare.gov; Use: The 

purpose of this submission is to 

continue to collect information from 

Internet users as they exit from the Web 

sites Medicare.gov and CMS.gov. To 

ensure that we gather information about 

user reactions to the Web sites, we have 

developed a survey tool that users can 

complete when they exit either site or 

by accessing a link on the bottom bar on 

the page. The responses on this survey 

tool will help CMS to make appropriate 

changes to the Web sites in the future. 

The survey tool contains questions 

about the information that visitors are 

seeking from the sites, the degree to 

which either site was useful to them, the 

improvements that they would like to 

see in the sites, and their general 

comments. Form Number: CMS–R–268 

(OMB# 0938–0756); Frequency: Yearly; 

Affected Public: Individuals and 

households, Private sector—Business or 

other for-profit; Number of 

Respondents: 7,000; Total Annual 

Responses: 9,100; Total Annual Hours: 

1,167. (For policy questions regarding 

this collection contact Matthew Aiken at 

410–786–1029. 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 May 9, 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: April 1, 2011. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2011–8464 Filed 4–7–11; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10252, CMS– 

1856 and CMS–1893] 

Agency Information Collection 

Activities: Proposed Collection; 

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) 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: Certificate of 

Destruction for Data Acquired from the 

Centers for Medicare and Medicaid 

Services; Use: The Certificate of 

Destruction is used by recipients of 

CMS data to certify that they have 

destroyed the data they have received 

through a CMS Data Use Agreement 

(DUA). The DUA requires the 

destruction of the data at the completion 

of the project/expiration of the DUA. 

The DUA addresses the conditions 

under which CMS will disclose and the 

User will maintain CMS data that are 

protected by the Privacy Act of 1974, 

§ 552a and the Health Insurance 

Portability Accountability Act of 1996. 

CMS has developed policies and 

procedures for such disclosures that are 

based on the Privacy Act and the Health 

Insurance Portability Act (HIPAA). The 

Certificate of Destruction is required to 

close out the DUA and to ensure the 

data are destroyed and not used for 

another purpose. Form Number: CMS– 

10252 (OMB# 0938–1046); Frequency: 

On occasion; Affected Public: Business 

or other for-profit; Number of 

Respondents: 500; Total Annual 

Responses: 500; Total Annual Hours: 

84. (For policy questions regarding this 

collection, contact Sharon Kavanagh at 

(410) 786–5441. For all other issues call 

(410) 786–1326.) 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: (CMS–1856) 

Request for Certification in the Medicare 

and/or Medicaid Program to Provide 

Outpatient Physical Therapy and/or 

Speech Pathology Services, and (CMS– 

1893) Outpatient Physical Therapy— 

Speech Pathology Survey Report; Use: 

CMS–1856 is used as an application to 

be completed by providers of outpatient 

physical therapy and/or speechVerDate Mar<15>2010 16:41 Apr 07, 2011 Jkt 223001 PO 00000 Frm 00037 Fmt 4703 Sfmt 4703 E:\FR\FM\08APN1.SGM 08APN1

srobinson on DSKHWCL6B1PROD with NOTICES
Federal Register / Vol. 76, No. 68 / Friday, April 8, 2011 / Notices 19777 

language pathology services requesting 

participation in Medicare/Medicaid 

programs. This form initiates the 

process for obtaining a decision as to 

whether the conditions of participation 

are met as a provider of outpatient 

physical therapy and/or speechlanguage pathology services. It is used 

by the State agencies to enter new 

provider into the ASPEN (Automated 

Survey Process Environment). CMS– 

1893 is used by the State survey agency 

to record data collected during an onsite survey of a provider of outpatient 

physical therapy and/or speechlanguage pathology services, to 

determine compliance with the 

applicable conditions of participation, 

and to report this information to the 

Federal Government. The form is 

primarily a coding worksheet designed 

to facilitate data reduction and retrieval 

into the ASPEN system. The 

information needed to make 

certification decisions is available to 

CMS only through the use of 

information abstracted from the form; 

Form Numbers: CMS–1856 and CMS– 

1893 (OMB#: 0938–0065); Frequency: 

Annually, occasionally; Affected Public: 

Private Sector; Business or other forprofit and not-for-profit institutions; 

Number of Respondents: 2,968; Total 

Annual Responses: 495; Total Annual 

Hours: 866. (For policy questions 

regarding this collection contact Georgia 

Johnson at 410–786–6859. 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 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 June 7, 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: April 1, 2011. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2011–8462 Filed 4–7–11; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10382] 

Emergency Clearance: Public 

Information Collection Requirements 

Submitted to the Office of Management 

and Budget (OMB) 

AGENCY: Center for Medicare and 

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 and 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 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. 

We are, however, requesting an 

emergency review of the information 

collection referenced below. In 

compliance with the requirement of 

section 3506(c)(2)(A) of the Paperwork 

Reduction Act of 1995, we have 

submitted to the Office of Management 

and Budget (OMB) the following 

requirements for emergency review. We 

are requesting an emergency review 

because the collection of this 

information is needed before the 

expiration of the normal time limits 

under OMB’s regulations at 5 CFR 

1320.13. This is necessary to ensure 

compliance with an initiative of the 

Administration. We cannot reasonably 

comply with the normal clearance 

procedures due to an unexpected event 

as stated in 5 CFR 1320.13(a)(2)(iii). The 

use of the normal clearance procedures 

would cause a statutory deadline to be 

missed. 

1. Type of Information Collection 

Request: New collection; Title of 

Information Collection: Medicaid 

Emergency Psychiatric Demonstration 

Use: Section 2707 of the Patient 

Protection and Affordable Care Act was 

enacted to implement a demonstration 

to study the effects of allowing 

Medicaid payment for the inpatient 

stabilization of a more serious mental 

health related problem. That is, to 

provide payment for inpatient 

stabilization for psychiatric patients 

aged 21 to 64 who express suicidal or 

homicidal gestures and are considered a 

danger to themselves or others. 

By allowing coverage for inpatient 

admission for emergency psychiatric 

treatment otherwise prohibited by the 

Medicaid institutions for mental 

diseases exclusion, the Demonstration 

may improve access to appropriate 

psychiatric care, improve quality of care 

for Medicaid patients, and encourage 

greater availability of inpatient 

psychiatric beds, thereby reducing the 

necessity of psychiatric boarding. 

As a condition for receiving payment 

under this Demonstration, a State shall 

be responsible for collecting and 

reporting information to the Centers for 

Medicare & Medicaid Services (CMS) 

about the conduct of the Demonstration 

in the State for the purposes of 

providing Federal oversight and the 

evaluation of the Demonstration and 

required to cooperate with the CMS 

evaluation team. CMS is also required to 

submit to Congress, a recommendation 

as to whether the Demonstration project 

should be continued after December 31, 

2013, and expanded on a national basis. 

The statute requires that a State 

seeking to participate in this 

Demonstration project shall submit an 

application that includes such 

information, provisions, and assurances 

necessary to assess the State’s ability to 

conduct the Demonstration as compared 

with other State applicants. The State 

Medical Director will submit the 

Demonstration application proposal. 

Form Number: CMS–10382 (OMB#: 

0938–New); Frequency: Once; Affected 

Public: Individuals or Households; 

Number of Respondents: 44; Total 

Annual Responses: 54; Total Annual 

Hours: 2,106. (For policy questions 

regarding this collection contact Diana 

Ayres 410–786–7203. For all other 

issues call 410–786–1326.) 

CMS is requesting OMB review and 

approval of this collection by May 9, 


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