Federal Register / Vol. 78, No. 110 / Friday, June 7, 2013 / Notices 34387 

Leading Age (formerly the American 

Association of Homes and Services for 

the Aging), National Center for Assisted 

Living, American Seniors Housing 

Association, and Assisted Living 

Federation of America; universities; 

foundations; and other private sector 

organizations. 

Burden is estimated at approximately 

2.5 hours per state each time the frame 

will be developed, including time to 

verify contact information, to respond to 

a semi-structured telephone protocol, 

and to develop the facility listing in an 

electronic format. Three year clearance 

is requested to cover two collections of 

frame information. The burden for the 

two collections is shown in Table 1 

below. There is no cost to respondents 

other than their time to participate. The 

total estimate of annualized burden is 

88 hours based on two data collections 

during the three year clearance period. 

TABLE 1—ESTIMATED ANNUALIZED BURDEN TABLE

Type of respondent Form name Number of 

respondents 

Number of 

responses/ 

respondent 

Average burden/response 

(in hours) 

State Government Representatives .......................... Contact info verification ....................... 34 1 5/60 

State Government Representatives .......................... Telephone protocol .............................. 34 1 30/60 

State Government Representatives .......................... Electronic file development .................. 34 1 2 

Ron A. Otten, 

Director, Office of Scientific Integrity, Office 

of the Associate Director for Science, Office 

of the Director, Centers for Disease Control 

and Prevention. 

[FR Doc. 2013–13455 Filed 6–6–13; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers: CMS–8003, CMS– 

10166, CMS–10184, CMS–10219, CMS– 

10242, CMS–2744, CMS–3070, CMS–10336, 

CMS–10220 and CMS–10175] 

Agency Information Collection 

Activities; Proposed Collection; 

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 

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: (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. 

DATES: Comments must be received by 

August 6, 2013. 

ADDRESSES: When commenting, please 

reference the document identifier or 

OMB control number (OCN). 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 http:// 

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. 

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. 

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 

http://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: This 

notice sets out a summary of the use and 

burden associated with the following 

information collections: 

CMS–8003—1915(c) Home and 

Community Based Services (HCBS) 

Waiver 

CMS–10166—Payment Error Rate 

Measurement in Medicaid & 

Children’s Health Insurance Program 

(CHIP) 

CMS–10184—Eligibility Error Rate 

Measurement in Medicaid and the 

Children’s Health Insurance Program 

CMS–10219—Healthcare Effectiveness 

Data and Information Set (HEDIS®) 

Data Collection for Medicare 

Advantage 

CMS–10242—Emergency and NonEmergency Ambulance Transports 

and Beneficiary Signature 

Requirements in 42 CFR 424.36(b) 

CMS–2744—End Stage Renal Disease 

(ESRD) Medical Information Facility 

Survey 

CMS–3070—Intermediate Care Facility 

(ICF) for the Mentally Retarded (MR) 

or Persons with Related Conditions 

Survey Report Form 

CMS–10336—Medicare and Medicaid 

Programs: Electronic Health Record 

Incentive Program 

CMS–10220—Security Consent and 

Surrogate Authorization Form 

CMS–10175—Certification Statement 

for Electronic File Interchange 

Organizations 

More detailed information can be 

found in each collection’s supporting 

statement and associated materials (see 

ADDRESSES). 

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 

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34388 Federal Register / Vol. 78, No. 110 / Friday, June 7, 2013 / Notices 

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. 

Proposed Information Collections 

1. Type of Information Collection 

Request: Reinstatement without change 

of a previously approved collection; 

Title of Information Collection: 1915(c) 

Home and Community Based Services 

(HCBS) Waiver; Use: The web-based 

application will be used by CMS to 

review and adjudicate individual waiver 

actions. The web-based application will 

also be used by states to submit and 

revise their waiver requests. Form 

Number: CMS–8003 (OCN: 0938–0449). 

Frequency: Yearly. Affected Public: 

State, Local, or Tribal Governments. 

Number of Respondents: 47. Total 

Annual Responses: 71. Total Annual 

Hours: 6,005. (For policy questions 

regarding this collection contact Kathy 

Poisal at 410–786–5940. For all other 

issues call 410–786–1326.) 

2. Type of Information Collection 

Request: Reinstatement of a previously 

approved collection; Title of 

Information Collection: Payment Error 

Rate Measurement in Medicaid & 

Children’s Health Insurance Program 

(CHIP); Use: The Improper Payments 

Information Act (IPIA) of 2002 as 

amended by the Improper Payments 

Elimination and Recovery Improvement 

Act (IPERIA) of 2012 requires CMS to 

produce national error rates for 

Medicaid and Children’s Health 

Insurance Program (CHIP). To comply 

with the IPIA, we will engage a federal 

contractor to produce the error rates in 

Medicaid and CHIP. The error rates for 

Medicaid and CHIP are calculated based 

on the reviews on three components of 

both Medicaid and CHIP program. They 

are: Fee-for-service claims medical 

reviews and data processing reviews, 

managed care claims data-processing 

reviews, and eligibility reviews. Each of 

the review components collects 

different types of information, and the 

state-specific error rates for each of the 

review components will be used to 

calculate an overall state-specific error 

rate, and the individual state-specific 

error rates will be used to produce a 

national error rate for Medicaid and 

CHIP. The states will be requested to 

submit, at their option, test data which 

include full claims details to the 

contractor prior to the quarterly 

submissions to detect potential 

problems in the dataset to and ensure 

the quality of the data. These states will 

be required to submit quarterly claims 

data to the contractor who will pull a 

statistically valid random sample, each 

quarter, by strata, so that medical and 

data processing reviews can be 

performed. State-specific error rates will 

be based on these review results. We 

need to collect the fee-for-service claims 

data, medical policies, and other 

information from states as well as 

medical records from providers in order 

for the contractor to sample and review 

adjudicated claims in those states 

selected for medical reviews and data 

processing reviews. Based on the 

reviews, state-specific error rates will be 

calculated which will serve as part of 

the basis for calculating national 

Medicaid and CHIP error rates. Form 

Number: CMS–10166 (OCN: 0938– 

0974); Frequency: Yearly, Quarterly; 

Affected Public: State, Local, or Tribal 

Governments; Number of Respondents: 

34; Total Annual Responses: 1650; Total 

Annual Hours: 56,100. (For policy 

questions regarding this collection 

contact Monetha Dockery at 410–786– 

0155. For all other issues call 410–786– 

1326.) 

3. Type of Information Collection 

Request: Reinstatement with a change of 

a previously approved collection; Title 

of Information Collection: Eligibility 

Error Rate Measurement in Medicaid 

and the Children’s Health Insurance 

Program; Use: The Improper Payments 

Information Act (IPIA) of 2002 requires 

us to produce national error rates for 

Medicaid and the Children’s Health 

Insurance Program (CHIP). To comply 

with the IPIA, we will use a national 

contracting strategy to produce error 

rates for Medicaid and CHIP fee-forservice and managed care improper 

payments. The federal contractor will 

review states on a rotational basis so 

that each state will be measured for 

improper payments, in each program, 

once and only once every three years. 

Subsequent to the first publication, 

we determined that we will measure 

Medicaid and CHIP in the same state. 

Therefore, states will measure Medicaid 

and CHIP eligibility in the same year 

measured for fee-for-service and 

managed care. We believe this approach 

will advantage states through economies 

of scale (e.g. administrative ease and 

shared staffing for both programs 

reviews). We also determined that 

interim case completion timeframes and 

reporting are critical to the integrity of 

the reviews and to keep the reviews on 

schedule to produce a timely error rate. 

Lastly, the sample sizes were increased 

slightly in order to produce an equal 

sample size per strata each month. Each 

month states submit a monthly sample 

selection list, eligibility review findings 

for active and negative cases and claims 

review findings. At the end of the cycle, 

states would have submitted 48 forms. 

We are submitting a new instrument in 

which we compile all of the information 

from the 48 forms into a format that will 

allow states to submit 12 forms for 12 

months of eligibility data. This form 

will also serve either of the data 

substitution options. Periodically, we 

will conduct federal re-reviews of states’ 

PERM files to ensure the accuracy of 

states’ review findings and the validity 

of the review process. We will select a 

random subsample of Medicaid and 

CHIP cases from the sample selection 

lists provided by each state. States will 

submit all pertinent information related 

to the review of each sampled case that 

we select. Form Number: CMS–10184 

(OCN: 0938–1012); Frequency: Yearly, 

Quarterly Affected Public: State, Local, 

or Tribal Governments; Number of 

Respondents: 34; Total Annual 

Responses: 120; Total Annual Hours: 

15,755. (For policy questions regarding 

this collection contact Monetha Dockery 

at 410–786–0155. For all other issues 

call 410–786–1326.) 

4. Type of Information Collection 

Request: Revision of a currently 

approved collection. Title of 

Information Collection: Healthcare 

Effectiveness Data and Information Set 

(HEDIS®) Data Collection for Medicare 

Advantage; Use: The data is used by 

CMS to: monitor Medicare Advantage 

organization performance, inform audit 

strategies, and inform beneficiary choice 

through their display in CMS’ 

consumer-oriented public compare tools 

and Web sites. Medicare Advantage 

organizations use the data for quality 

assessment and as part of their quality 

improvement programs and activities. 

Quality Improvement Organizations and 

CMS contractors use HEDIS® data in 

conjunction with their statutory 

authority to improve quality of care, and 

consumers who are making informed 

health care choices. In addition, we 

make health plan level HEDIS® data 

available to researchers and others as 

public use files at www.cms.hhs.gov. 

Form Number: CMS–10219 (OCN: 

0938–1028). Frequency: Yearly. Affected 

Public: Private sector (business or other 

for-profit and not-for-profit institutions); 

Number of Respondents: 576. Total 

Annual Responses: 576. Total Annual 

Hours: 184,320. (For policy questions 

regarding this collection contact Lori 

Teichman at 410–786–6684. For all 

other issues call 410–786–1326.) 

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Federal Register / Vol. 78, No. 110 / Friday, June 7, 2013 / Notices 34389 

5. Type of Information Collection 

Request: Reinstatement with change of a 

previously approved collection; Title of 

Information Collection: Emergency and 

Non-Emergency Ambulance Transports 

and Beneficiary Signature Requirements 

in 42 CFR 424.36(b); Use: Ambulance 

providers and suppliers are the primary 

information users. Specifically, when 

ambulance providers and suppliers sign 

claims on behalf of beneficiaries they 

are required by § 424.36(b)(6) to keep 

certain documentation in their files for 

at least four years from the date of 

service. The purpose of this information 

collection is to document emergency 

and nonemergency ambulance 

transports where the beneficiary was 

incapable of signing the claim and the 

ambulance provider or supplier signed 

the claim on the beneficiary’s behalf. 

The information may also be used by: 

(1) Our Part A and Part B Medicare 

Administrative Contractors that process 

and pay ambulance claims; (2) our staff 

who review and audit claims for 

medical necessity; (3) our staff who 

review claims for overpayments; and (4) 

by others who investigate ambulance 

billing practices to ensure compliance 

under the False Claims Act and antikickback statute. Therefore, besides 

ambulance providers and suppliers, the 

information collected may be used by 

CMS, the Office of the General Counsel, 

the Office of the Inspector General, the 

Department of Justice, and the Federal 

Bureau of Investigations. Form Number: 

CMS–10242 (OCN: 0938–1049). 

Frequency: Occasionally. Affected 

Public: Private sector (business or other 

for-profit and not-for-profit institutions). 

Number of Respondents: 11,564. Total 

Annual Responses: 15,633,781. Total 

Annual Hours: 1,303,857. (For policy 

questions regarding this collection 

contact David Walczak at 410–786– 

4475. For all other issues call 410–786– 

1326.) 

6. Type of Information Collection 

Request: Revision of a previously 

approved collection; Title of 

Information Collection: End Stage Renal 

Disease (ESRD) Medical Information 

Facility Survey; Use: The End Stage 

Renal Disease (ESRD) Medical 

Information Facility Survey form (CMS– 

2744) is completed annually by 

Medicare-approved providers of dialysis 

and transplant services. The CMS–2744 

is designed to collect information 

concerning treatment trends, utilization 

of services and patterns of practice in 

treating ESRD patients. The information 

is used to assess and evaluate the local, 

regional and national levels of medical 

and social impact of ESRD care and is 

used extensively by researchers and 

suppliers of services for trend analysis. 

The information is available on the CMS 

Dialysis Facility Compare Web site and 

will enable patients to make informed 

decisions about their care by comparing 

dialysis facilities in their area. Form 

Number: CMS–2744 (OCN: 0938–0447); 

Frequency: Yearly; Affected Public: 

Business or other for-profit, Not-forprofit institutions; Number of 

Respondents: 5,964; Total Annual 

Responses: 5,964; Total Annual Hours: 

47,712. (For policy questions regarding 

this collection contact Michelle Tucker 

at 410–786–0736. For all other issues 

call 410–786–1326.) 

7. Type of Information Collection 

Request: Reinstatement with change of a 

currently approved collection; Title of 

Information Collection: Intermediate 

Care Facility (ICF) for the Mentally 

Retarded (MR) or Persons with Related 

Conditions Survey Report Form; Use: 

This survey form is needed to ensure 

intermediate care facility (ICF) for the 

mentally retarded (MR) provider and 

client characteristics are available and 

updated annually for the federal 

government’s Online Survey 

Certification and Reporting (OSCAR) 

system. It is required for the provider to 

fill out at the time of the annual 

recertification or initial certification 

survey conducted by the state Medicaid 

agency. The team leader for the state 

survey team must review and approve 

the completed form before completion 

of the survey. The state Medicaid survey 

agency is responsible for transferring the 

3070 information into OSCAR. Form 

Number: CMS–3070 (OCN: 0938–0062); 

Frequency: Reporting—Yearly; Affected 

Public: Private Sector: Business or other 

for-profits and Not-for-profit 

institutions; Number of Respondents: 

6,446; Total Annual Responses: 6,446; 

Total Annual Hours: 19,388. (For policy 

questions regarding this collection 

contact Adrienne Rogers at 410–786– 

3411. For all other issues call 410–786– 

1326.) 

8. Type of Information Collection 

Request: Reinstatement with change of a 

previously approved collection; Title of 

Information Collection: Medicare and 

Medicaid Programs: Electronic Health 

Record Incentive Program; Use: The 

American Recovery and Reinvestment 

Act of 2009 (Recovery Act) (Pub. L. 111– 

5) was enacted on February 17, 2009. 

The Recovery Act includes many 

measures to modernize our nation’s 

infrastructure, and improve affordable 

health care. Expanded use of health 

information technology (HIT) and 

certified electronic health record (EHR) 

technology will improve the quality and 

value of America’s health care. Title IV 

of Division B of the Recovery Act 

amends Titles XVIII and XIX of the 

Social Security Act (the Act) by 

establishing incentive payments to 

eligible professionals (EPs), eligible 

hospitals and critical access hospitals 

(CAHs), and Medicare Advantage (MA) 

organizations participating in the 

Medicare and Medicaid programs that 

adopt and successfully demonstrate 

meaningful use of certified EHR 

technology. These Recovery Act 

provisions, together with Title XIII of 

Division A of the Recovery Act, may be 

cited as the ‘‘Health Information 

Technology for Economic and Clinical 

Health Act’’ or the ‘‘HITECH Act.’’ 

The HITECH Act creates incentive 

programs for EPs and eligible hospitals, 

including CAHs, in the Medicare Feefor-Service (FFS), MA, and Medicaid 

programs that successfully demonstrate 

meaningful use of certified EHR 

technology. In their first payment year, 

Medicaid EPs and eligible hospitals may 

adopt, implement or upgrade to certified 

EHR technology. It also, provides for 

payment adjustments in the Medicare 

FFS and MA programs starting in FY 

2015 for EPs and eligible hospitals 

participating in Medicare that are not 

meaningful users of certified EHR 

technology. These payment adjustments 

do not pertain to Medicaid providers. 

The first final rule for the Medicare 

and Medicaid EHR Incentive Program, 

which was published in the Federal 

Register on July 28, 2010 (CMS–0033– 

F), specified the initial criteria EPs, 

eligible hospitals and CAHs, and MA 

organizations must meet in order to 

qualify for incentive payments; 

calculation of incentive payment 

amounts; payment adjustments under 

Medicare for covered professional 

services and inpatient hospital services 

provided by EPs, eligible hospitals and 

CAHs failing to demonstrate meaningful 

use of certified EHR technology 

beginning in 2015; and other program 

participation requirements. On the same 

date, the Office of the National 

Coordinator of Health Information 

Technology (ONC) issued a closely 

related final rule (45 CFR part 170, RIN 

0991–AB58) that specified the initial set 

of standards, implementation 

specifications, and certification criteria 

for certified EHR technology. ONC has 

also issued a separate final rule on the 

establishment of certification programs 

for health information technology (HIT) 

(45 CFR part 170, RIN 0991–AB59). The 

functionality of certified EHR 

technology should facilitate the 

implementation of meaningful use. 

Subsequently, final rules have been 

issued by CMS (77 FR 53968) and ONC 

(77 FR 72985) to create a Stage 2 of 

meaningful use criteria and other 

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34390 Federal Register / Vol. 78, No. 110 / Friday, June 7, 2013 / Notices 

changes to the CMS EHR Incentive 

Programs and the 2014 Edition 

Certification Criteria for EHR 

technology. 

The information collection 

requirements contained in this 

information collection request are 

needed to implement the HITECH Act. 

In order to avoid duplicate payments, 

all EPs are enumerated through their 

National Provider Identifier (NPI), while 

all eligible hospitals and CAHs are 

enumerated through their CMS 

Certification Number (CCN). State 

Medicaid agencies and CMS use the 

provider’s tax identification number and 

NPI or CCN combination in order to 

make payment, validate payment 

eligibility and detect and prevent 

duplicate payments for EPs, eligible 

hospitals and CAHs. Form Number: 

CMS–10336 (OCN: 0938–1158). 

Frequency: Occasionally; Affected 

Public: Private sector. Number of 

Respondents: 214, 694; Total Annual 

Responses: 214,694. Total Annual 

Hours: 2,034,740.16. (For policy 

questions regarding this collection 

contact Travis Broome at 214–767–4450. 

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

9. Type of Information Collection 

Request: Reinstatement with change of a 

previously approved collection; Title of 

Information Collection: Security 

Consent and Surrogate Authorization 

Form; Use: The primary function of the 

Medicare enrollment application is to 

obtain information about the Provider or 

supplier and whether they meet the 

Federal and/or State qualifications to 

participate in the Medicare program. In 

addition, the Medicare enrollment 

application gathers information 

regarding the provider or supplier’s 

practice location, the identity of the 

owners of the enrolling organization, 

and information necessary to establish 

the correct claims payment. 

Enrollees have the option of 

submitting either a CMS 855 form, or 

submitting information via a web based 

process. In establishing a web based 

application process, we allow providers 

and suppliers the ability to enroll in the 

Medicare program, revalidate their 

enrollment and make changes to their 

enrollment information via Internetbased Provider Enrollment, Chain and 

Ownership System (PECOS). Individual 

providers/suppliers (hereinafter referred 

to as ‘‘Individual Providers’’) log into 

Internet-based PECOS using their User 

IDs and passwords established when 

they applied on-line to the National 

Plan and Provider Enumeration System 

(NPPES) for their National Provider 

Identifiers (NPIs). Authorized Officials 

(AOs) of the provider or supplier 

organizations (hereinafter referred to as 

‘‘Organizational Providers’’) must 

register for a user account and 

authenticate their identity and 

connection to the organization they 

represent before being able to log into 

Internet-based PECOS. Once 

authenticated, AOs for Organizational 

Providers, receive complete access to 

their enrollment information via 

Internet-based PECOS. Individuals and 

AOs of Organizational Providers are not 

required to submit a Security Consent 

and Surrogate Authorization Form to 

enroll, revalidate or make changes to 

their Medicare enrollment information. 

Individual and Organizational 

Providers may complete their Medicare 

enrollment responsibilities on their own 

or elect to delegate this task to a 

Surrogate. A Surrogate is an individual 

or organization identified by an 

Individual or Organizational Provider as 

someone authorized to access CMS 

computer systems, such as Internetbased PECOS, National Provider Plan 

and Enumeration System (NPPES) and 

the Medicare and Medicaid Electronic 

Health Records (EHR) Incentive Program 

Registration and Attestation System 

(HITECH), on their behalf and to modify 

or view any information contained 

therein that the Individual or 

Organizational Provider may have 

permission or right to access in 

accordance with Medicare statutes, 

regulations, policies, and usage 

guidelines for any CMS system. 

Surrogates may consist of administrative 

staff, independent contractors, 3rd party 

consulting companies or credentialing 

departments. In order for an Individual 

or Organizational Provider to delegate 

the Medicare credentialing process to a 

Surrogate to access and update their 

enrollment information in the above 

mentioned CMS systems on their behalf, 

it is required that a Security Consent 

and Surrogate Authorization Form be 

completed, or Individual and 

Organizational Providers use an 

equivalent online process via the 

PECOS Identity and Access 

Management (I&A) system. The Security 

Consent and Surrogate Authorization 

form replicates business service 

agreements between Medicare 

providers, suppliers or both and 

Surrogates providing enrollment 

services. 

We are proposing one version of the 

Security Consent and Surrogate 

Authorization Form. The form, once 

signed, mailed and approved, grants a 

Surrogate access to all current and 

future enrollment data for the 

Individual or Organization Provider. 

Form Number: CMS–10220 (OCN: 

0938–1035). Frequency: Occasionlly. 

Affected Public: Individuals and Private 

Sector; Number of Respondents: 88,650; 

Total Annual Responses: 88,650; Total 

Annual Hours: 22,162. (For policy 

questions regarding this collection 

contact Alisha Banks at 410–786–0671. 

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

10. Type of Information Collection 

Request: Reinstatement with change of a 

previously approved collection; Title of 

Information Collection: Certification 

Statement for Electronic File 

Interchange Organizations; Use: Health 

care providers can currently obtain a 

National Provider Identifier (NPI) via a 

paper application or over the Internet 

through the National Plan and Provider 

Enumeration System (NPPES). These 

applications must be submitted 

individually, on a per-provider basis. 

The Electronic File Interchange (EFI) 

process allows provider-designated 

organizations (EFIOs) to capture 

multiple providers’ NPI application 

information on a single electronic file 

for submission to NPPES. This process 

is also referred to as bulk enumeration. 

To ensure that the EFIO has the 

authority to act on behalf of each 

provider and complies with other 

federal requirements, an authorized 

official of the EFIO must sign a 

certification statement and mail it to us. 

Form Number: CMS–10175 (OCN: 

0938–0984). Frequency: Occasionally. 

Affected Public: Private Sector; Number 

of Respondents: 25; Total Annual 

Responses: 25; Total Annual Hours: 75. 

(For policy questions regarding this 

collection contact Leslie Jones at 410– 

786–6599. For all other issues call 410– 

786–1326.) 

Dated: June 4, 2013. 

Martique Jones, 

Deputy Director, Regulations Development 

Group, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2013–13578 Filed 6–6–13; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10309, CMS– 

10475, CMS–R–5 and CMS–R–234] 

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 

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