[Federal Register Volume 86, Number 9 (Thursday, January 14, 2021)]
[Notices]
[Pages 3158-3159]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-00762]


-----------------------------------------------------------------------

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/PRA-Listing.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 premium-free 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

[[Page 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