[Federal Register Volume 75, Number 43 (Friday, March 5, 2010)]
[Notices]
[Pages 10279-10280]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-4313]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-3070 and CMS-416]


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: Extension of a currently 
approved collection; Title of

[[Page 10280]]

Information Collection: Intermediate Care Facility (ICF) for the 
Mentally Retarded (MR) or Persons with Related Conditions Survey Report 
Form and Supporting Regulations at 42 CFR 442.30, 483.410, 483.420, 
483.440, 483.450 and 483.460; Use: This survey form is needed to ensure 
ICF/MR provider and client characteristics are available and updated 
annually for the Federal government's Online Survey Certification and 
Reporting (OSCAR) system. It is required for the provider to fill out 
at the time of the annual recertification or initial certification 
survey conducted by the State Medicaid agency. The team leader for the 
State survey team must review and approve the completed form before 
completion of the survey. The State Medicaid survey agency is 
responsible for transferring the 3070 information into OSCAR. Form 
Number: CMS-3070 (OMB<greek-i>: 0938-0062); Frequency: Reporting--
Yearly; Affected Public: Private Sector: Business or other for-profits 
and Not-for-profit institutions; Number of Respondents: 6,437; Total 
Annual Responses: 6,437; Total Annual Hours: 19,311. (For policy 
questions regarding this collection contact Kelley Tinsley at 410-786-
6664. For all other issues call 410-786-1326.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Annual Early and 
Periodic Screening, Diagnostic and Treatment (EPSDT) Services 
Participation Report; Form Number: CMS-416 (OMB<greek-i>: 0938-0354); 
Use: States are required to submit an annual report on the provision of 
EPSDT services pursuant to section 1902(a)(43)(D) of the Social 
Security Act. These reports provide CMS with data necessary to assess 
the effectiveness of State EPSDT programs, to determine a State's 
results in achieving its participation goal and to respond to 
inquiries. Respondents are State Medicaid Agencies. The data is due 
April 1 of every year so States need to have the form and instructions 
as soon as possible in order to report timely. Frequency: Yearly; 
Affected Public: State, Tribal and Local governments; Number of 
Respondents: 56; Total Annual Responses: 56; Total Annual Hours: 504. 
(For policy questions regarding this collection contact Cindy Ruff at 
410-786-5916. 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 
E-mail your request, including your address, phone number, OMB number, 
and CMS document identifier, to <a href="/cdn-cgi/l/email-protection#f8a899889d8a8f978a93b89b958bd690908bd69f978e"><span class="__cf_email__" data-cfemail="8cdcedfce9fefbe3fee7ccefe1ffa2e4e4ffa2ebe3fa">[email protected]</span></a>, 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 April 5, 2010.
    OMB, Office of Information and Regulatory Affairs.
    Attention: CMS Desk Officer.
    Fax Number: (202) 395-6974.
    E-mail: <a href="/cdn-cgi/l/email-protection#36797f6477694543545b5f45455f595876595b541853594618515940"><span class="__cf_email__" data-cfemail="9dd2d4cfdcc2eee8fff0f4eeeef4f2f3ddf2f0ffb3f8f2edb3faf2eb">[email protected]</span></a>.

    Dated: February 24, 2010.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 2010-4313 Filed 3-4-10; 8:45 am]
BILLING CODE 4120-01-P


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