72826 Federal Register / Vol. 75, No. 227 / Friday, November 26, 2010 / Notices 

A. Federal Reserve Bank of 

Minneapolis (Jacqueline G. King, 

Community Affairs Officer) 90 

Hennepin Avenue, Minneapolis, 

Minnesota 55480–0291: 1. James A. 

Jorgenson, Kenmare, North Dakota; as 

an individual, to acquire and retain 

voting shares of Bozeman Bancorp, Inc., 

and thereby indirectly acquire and 

retain control of Bank of Bozeman, both 

of Bozeman, Montana. 

Board of Governors of the Federal Reserve 

System, November 19, 2010. 

Robert deV. Frierson, 

Deputy Secretary of the Board. 

[FR Doc. 2010–29681 Filed 11–24–10; 8:45 am] 

BILLING CODE 6210–01–P 

FEDERAL RESERVE SYSTEM 

Formations of, Acquisitions by, and 

Mergers of Bank Holding Companies 

The companies listed in this notice 

have applied to the Board for approval, 

pursuant to the Bank Holding Company 

Act of 1956 (12 U.S.C. 1841 et seq.) 

(BHC Act), Regulation Y (12 CFR part 

225), and all other applicable statutes 

and regulations to become a bank 

holding company and/or to acquire the 

assets or the ownership of, control of, or 

the power to vote shares of a bank or 

bank holding company and all of the 

banks and nonbanking companies 

owned by the bank holding company, 

including the companies listed below. 

The applications listed below, as well 

as other related filings required by the 

Board, are available for immediate 

inspection at the Federal Reserve Bank 

indicated. The application also will be 

available for inspection at the offices of 

the Board of Governors. Interested 

persons may express their views in 

writing on the standards enumerated in 

the BHC Act (12 U.S.C. 1842(c)). If the 

proposal also involves the acquisition of 

a nonbanking company, the review also 

includes whether the acquisition of the 

nonbanking company complies with the 

standards in section 4 of the BHC Act 

(12 U.S.C. 1843). Unless otherwise 

noted, nonbanking activities will be 

conducted throughout the United States. 

Unless otherwise noted, comments 

regarding each of these applications 

must be received at the Reserve Bank 

indicated or the offices of the Board of 

Governors not later than December 20, 

2010. 

A. Federal Reserve Bank of 

Minneapolis (Jacqueline G. King, 

Community Affairs Officer) 90 

Hennepin Avenue, Minneapolis, 

Minnesota 55480–0291: 1. Bitterroot 

Holding Company, Lolo, Montana; to 

acquire additional voting shares of West 

One Bank, Kalispell, Montana. 

Comments regarding this application 

must be received not later than 

December 13, 2010. 

B. Federal Reserve Bank of Dallas (E. 

Ann Worthy, Vice President) 2200 

North Pearl Street, Dallas, Texas 75201– 

2272: 

1. Carlile Bancshares, Inc., Fort 

Worth, Texas; to become a bank holding 

company by acquiring 100 percent of 

the voting shares of Treaty Oak Bank, 

Austin, Texas. 

Board of Governors of the Federal Reserve 

System, November 22, 2010. 

Robert deV. Frierson, 

Deputy Secretary of the Board. 

[FR Doc. 2010–29724 Filed 11–24–10; 8:45 am] 

BILLING CODE 6210–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–116 and CMS– 

417] 

Agency Information Collection 

Activities: Submission for OMB 

Review; 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), 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 function; 

(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: Clinical 

Laboratory Improvement Amendments 

(CLIA) Application Form and 

Supporting Regulations in 42 CFR 

493.1–.2001Medicare/Medicaid 

Psychiatric Hospital Survey Data; Use: 

The application must be completed by 

entities performing laboratory’s testing 

specimens for diagnostic or treatment 

purposes. This information is vital to 

the certification process. Form Number: 

CMS–116 (OMB#: 0938–0581); 

Frequency: Biennially and Occasionally; 

Affected Public: Private Sector: Business 

or other for-profits and Not-for-profit 

institutions; Number of Respondents: 

219,000; Total Annual Responses: 

31,520; Total Annual Hours: 23,640. 

(For policy questions regarding this 

collection contact Sheila Ward at 410– 

786–3115. For all other issues call 410– 

786–1326.) 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Hospice Request 

for Certification in the Medicare 

Program; Use: The Hospice Request for 

Certification Form is the identification 

and screening form used to initiate the 

certification process and to determine if 

the provider has sufficient personnel to 

participate in the Medicare program. 

Form Number: CMS–417 (OMB#: 0938– 

0313); Frequency: Annually; Affected 

Public: Private Sector: Business or other 

for-profits; Number of Respondents: 

3,494; Total Annual Responses: 3,494; 

Total Annual Hours: 594. (For policy 

questions regarding this collection 

contact Debbie Terkay at 410–786–6835. 

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 December 27, 2010. 

OMB, Office of Information and 

Regulatory Affairs, Attention: CMS 

Desk Officer, 

Fax Number: (202) 395–6974. 

E-mail: OIRA_submission@omb.eop.gov. 

Dated: November 18, 2010. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2010–29718 Filed 11–24–10; 8:45 am] 

BILLING CODE 4120–01–P 


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