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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 outpatientphysical 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 08APN1srobinson on DSKHWCL6B1PROD with NOTICES

### 19777 Federal Register/ Vol. 76, No. 68 / Friday, April 8, 2011 / Notices

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 outpatientphysical 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 agencyto record data collected during an onsite survey of a provider of outpatientphysical 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,