Document Headings

                    Document headings vary by document type but may contain                    the following:                  
                -                       the agency or agencies that issued and signed a document                    
                -                       the number of the CFR title and the number of each part                      the document amends, proposes to amend, or is directly                      related to                    
                -                       the agency docket number / agency internal file number                    
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###### Department of Health and Human Services

###### Centers for Medicare & Medicaid Services

          - [Document Identifier CMS-10367]

# 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                           ( print page 80821)                        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:*                     New collection (Request for a new OMB Control Number);                     *Title of Information Collection:*                     Medicaid State Plan Preprint for Use by States When Implementing Section 6505 of the [Patient Protection and] Affordable Care Act;                     *Use:*                     [The] CMS has developed a Medicaid State Plan Preprint for use by States and specific to support the January 1, 2011, mandate of the prohibition on payments outside of the United States. The Preprint follows the format and requested information from prior preprints provided to the States by CMS and provides a placeholder and assurance of compliance with section 1902(a) of the Social Security Act;                     *Form Number:*                     CMS-10367 (OMB#: 0938-NEW);                     *Frequency:*                     Occasionally;                     *Affected Public:*                     State, Local, or Tribal Governments;                     *Number of Respondents:*                     56;                     *Total Annual Responses:*                     56;                     *Total Annual Hours:*                     5. (For policy questions regarding this collection contact Carla Ausby at 410-786-2153. 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 e-mail 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.                

                    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                     *February 22, 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: December 17, 2010.

Martique Jones,

Director, Regulations Development Division-B, Office of Strategic Operations and Regulatory Affairs.

[FR Doc. 2010-32197 Filed 12-22-10; 8:45 am]

BILLING CODE 4120-01-P