Document Headings

                    Document headings vary by document type but may contain                    the following:                  
                -                       the agency or agencies that issued and signed a document                    
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###### Department of Health and Human Services

###### Centers for Medicare and Medicaid Services

          - [Document Identifier: CMS-10120]

# AGENCY:

Centers for Medicare and Medicaid Services. 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) (formerly known as the Health Care Financing Administration (HCFA), 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.

                        1.                         *Type of Information Collection Request:*                         New Collection;                         *Title of Information Collection:*                         1932 State Plan Amendment Template, State Plan Requirements and Supporting Regulations in 42 CFR 438.50;                         *Form No.:*                         CMS-10120 (OMB#0938-NEW);                         *Use:*                         The State Medicaid Agencies will complete the template. CMS will review the information to determine if the State has met all the requirements under 1932(1)(1)(A) and 42 CFR 438.50. Once all requirements are met, the State will be allowed to enroll Medicaid beneficiaries on a mandatory basis into managed care entities without section 1115 or 1915(b) waiver authority.;                         *Frequency:*                         On occasion;                         *Affected Public:*                         State, local, or tribal government;                         *Number of Respondents:*                         56;                         *Total Annual Responses:*                         10;                         *Total Annual Hours:*                         100.                    

                        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/​regulations/​pra/​,*                         or E-mail your request, including your address, phone number, OMB number, and CMS document identifier, to                         *Paperwork@hcfa.gov,*                         or call the Reports Clearance Office at (410) 786-1326. Written comments and recommendations for the proposed information collections must be mailed within 30 days of this notice directly to the OMB desk officer: OMB Human Resources and Housing Branch, Attention: Christopher Martin, New Executive Office Building, Room 10235, Washington, DC 20503.                    

Dated: October 28, 2004.

John P. Burke, III,

Paperwork Reduction Act Team Leader, CMS Reports Clearance Officer, Office of Strategic Operations and Regulatory Affairs, Division of Regulations Development and Issuances.

[FR Doc. 04-24780  Filed 11-4-04; 8:45 am]

BILLING CODE 4120-03-M