3158 Federal Register / Vol. 86, No. 9 / Thursday, January 14, 2021 / Notices 

The Director, Strategic Business 

Initiatives Unit, Office of the Chief 

Operating Officer, Centers for Disease 

Control and Prevention, has been 

delegated the authority to sign Federal 

Register notices pertaining to 

announcements of meetings and other 

committee management activities, for 

both the Centers for Disease Control and 

Prevention and the Agency for Toxic 

Substances and Disease Registry. 

Kalwant Smagh, 

Director, Strategic Business Initiatives Unit, 

Office of the Chief Operating Officer, Centers 

for Disease Control and Prevention. 

[FR Doc. 2021–00572 Filed 1–13–21; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–43 and CMS– 

381] 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, Health and Human 

Services (HHS). 

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 

a second opportunity for public 

comment on the notice. Interested 

persons are invited to send comments 

regarding the burden estimate or any 

other aspect of this collection of 

information, including the necessity and 

utility of the proposed information 

collection for the proper performance of 

the agency’s functions, the accuracy of 

the estimated burden, ways to enhance 

the quality, utility, and clarity of the 

information to be collected, and the use 

of automated collection techniques or 

other forms of information technology to 

minimize the information collection 

burden. 

DATES: Comments on the collection(s) of 

information must be received by the 

OMB desk officer by February 16, 2021. 

ADDRESSES: Written comments and 

recommendations for the proposed 

information collection should be sent 

within 30 days of publication of this 

notice to www.reginfo.gov/public/do/ 

PRAMain. Find this particular 

information collection by selecting 

‘‘Currently under 30-day Review—Open 

for Public Comments’’ or by using the 

search function. 

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’ Website address at 

website address at https://www.cms.gov/ 

Regulations-and-Guidance/Legislation/ 

PaperworkReductionActof1995/PRAListing.html. 

2. Call the Reports Clearance Office at 

(410) 786–1326. 

FOR FURTHER INFORMATION CONTACT: 

William Parham at (410) 786–4669. 

SUPPLEMENTARY INFORMATION: 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 provide 

information to a third party. Section 

3506(c)(2)(A) of the PRA (44 U.S.C. 

3506(c)(2)(A)) requires federal agencies 

to publish a 30-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 that summarizes 

the following proposed collection(s) of 

information for public comment: 

1. Type of Information Collection 

Request: Extension without change of a 

currently approved collection; Title of 

Information Collection: Application for 

Health Insurance Benefits Under 

Medicare for Individual with Chronic 

Renal Disease and Supporting 

Regulations in 42 CFR; Use: Individuals 

with End-Stage Renal Disease (ESRD) 

have the opportunity to apply for 

Medicare benefits and obtain premiumfree Part A if they meet certain criteria 

outlined in statute. Sections 226A of the 

Act authorizes entitlement for Medicare 

Hospital Insurance (Part A) if the 

individual with ESRD files an 

application for benefits and meets the 

requisite contributions through one’s 

own employment or the employment of 

a related individual to meet the 

statutory definition of a ‘‘currently 

insured’’ individual outlined in section 

214 of the Act. Further, for individuals 

who meet the requirements for 

premium-free Part A entitlement, 

Medicare coverage starts based on the 

dates in which the individual started 

dialysis treatment or had a kidney 

transplant. These statutory provisions 

are codified at 42 CFR 406.7(c)(3) and 

407.13. 

The CMS–43 form is used (in 

conjunction with the CMS–2728, OMB 

control number 0938–0046) to establish 

entitlement to Medicare Part A and 

enrollment in Medicare Part B for 

individuals with ESRD. Form CMS–43 

is only used for initial applications for 

Medicare by individuals diagnosed with 

ESRD. Form CMS–2728 provides the 

medical documentation that the 

individual has ESRD, and it 

accompanies Form CMS–43. 

Form CMS–43 is completed by the 

person applying for Medicare or by an 

SSA representative using information 

provided by the Medicare enrollee 

during an in-person interview. The 

majority of the forms are completed by 

an SSA representative on behalf of the 

individual applying for Medicare 

benefits. Form Number: CMS–43 (OMB 

control number: 0938–0080); Frequency: 

Yearly; Affected Public: State, Local, or 

Tribal Governments; Number of 

Respondents: 20,382; Total Annual 

Responses: 20,382; Total Annual Hours: 

8,560. (For policy questions regarding 

this collection contact Carla Patterson at 

410–786–1000.) 

2. Type of Information Collection 

Request: Revision 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; Use: Form 

CMS–381 was developed to ensure that 

each OPT/OSP extension location at 

which OPT/OSP providers furnish 

services, must be reported by the 

providers to the State Survey Agencies 

(SAs). Form CMS–381 is completed 

when: (1) New OPT/OSP providers 

enter the Medicare program; (2) when 

existing OPT/OPS providers delete or 

add a service, or close or add an 

extension location; or, (3) when existing 

OPT/OSP providers are recertified by 

the State Survey Agency every 6 years. 

Form Number: CMS–381 (OMB control 

number: 0938–0273); Frequency: 

Occasionally; Affected Public: Private 

Sector; Business or other for-profit and 

not-for-profit institutions; Number of 

Respondents: 2,083; Total Annual 


khammond on DSKJM1Z7X2PROD with NOTICES
Federal Register / Vol. 86, No. 9 / Thursday, January 14, 2021 / Notices 3159 

Responses: 443; Total Annual Hours: 

111. (For policy questions regarding this 

collection contact Caroline Gallaher at 

410–786–8705.) 

Dated: January 11, 2021. 

William N. Parham, III, 

Director, Paperwork Reduction Staff,Office of 

Strategic Operations and Regulatory Affairs. 

[FR Doc. 2021–00762 Filed 1–13–21; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers CMS–10147] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, Health and Human 

Services (HHS). 

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 (the 

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 

the necessity and utility of the proposed 

information collection for the proper 

performance of the agency’s functions, 

the accuracy of the estimated burden, 

ways to enhance the quality, utility, and 

clarity of the information to be 

collected, and the use of automated 

collection techniques or other forms of 

information technology to minimize the 

information collection burden. 

DATES: Comments must be received by 

March 15, 2021. 

ADDRESSES: When commenting, please 

reference the document identifier or 

OMB control number. 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 ll, 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’ website address at 

website address at https://www.cms.gov/ 

Regulations-and-Guidance/Legislation/ 

PaperworkReductionActof1995/PRAListing.html. 

2. Call the Reports Clearance Office at 

(410) 786–1326. 

FOR FURTHER INFORMATION CONTACT: 

William N. Parham at (410) 786–4669. 

SUPPLEMENTARY INFORMATION: 

Contents 

This notice sets out a summary of the 

use and burden associated with the 

following information collections. More 

detailed information can be found in 

each collection’s supporting statement 

and associated materials (see 

ADDRESSES). 

CMS–10147—Medicare Prescription 

Drug Coverage and Your Rights 

Under the 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 

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. 

Information Collection 

1. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Medicare 

Prescription Drug Coverage and Your 

Rights; Use: Section 423.562(a)(3) and 

an associated regulatory provision at 

§ 423.128(b)(7)(iii) require that Part D 

plan sponsors’ network pharmacies 

provide Part D enrollees with a printed 

copy of our standardized pharmacy 

notice ‘‘Medicare Prescription Drug 

Coverage and Your Rights’’ (hereafter, 

‘‘notice’’) if an enrollee’s prescription 

cannot be filled. 

The purpose of this notice is to 

provide enrollees with information 

about how to contact their Part D plans 

to request a coverage determination, 

including a request for an exception to 

the Part D plan’s formulary. The notice 

reminds enrollees about certain rights 

and protections related to their 

Medicare prescription drug benefits, 

including the right to receive a written 

explanation from the drug plan about 

why a prescription drug is not covered. 

Through delivery of this standardized 

notice, a Part D plan sponsor’s network 

pharmacies are in the best position to 

inform enrollees at point of sale about 

how to contact their Part D plan if the 

prescription cannot be filled. Form 

Number: CMS–10147, OMB 0938–0975; 

Frequency: Annually; Affected Public: 

Private Sector, Business or other forprofits; Number of Respondents: 70,000; 

Number of Responses: 49,681,292; Total 

Annual Hours: 827,690. (For questions 

regarding this collection, contact Trevor 

Rose at (410) 786 7768.) 

Dated: January 8, 2021. 

William N. Parham, III, 

Director, Paperwork Reduction Staff, Office 

of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2021–00587 Filed 1–13–21; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Meeting of the Advisory Committee on 

Minority Health 

AGENCY: Office of Minority Health, 

Office of the Secretary, Department of 

Health and Human Services. 

ACTION: Notice of meeting. 

SUMMARY: As stipulated by the Federal 

Advisory Committee Act, the U.S. 

Department of Health and Human 

Services (HHS or Department) is hereby 

giving notice that the Advisory 

Committee on Minority Health (ACMH) 

will hold a meeting. This meeting will 

be open to the public. Preregistration is 

required for the public to attend the 

meeting, provide comments, and/or 

distribute printed material(s) to ACMH 

members. Information about the meeting 

will be posted on the HHS Office of 

Minority Health (OMH) website: 


khammond on DSKJM1Z7X2PROD with NOTICES