### 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**