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                    
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###### Department of Health and Human Services

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

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

# 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                                   ( print 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#: 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#: 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                         *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                         *April 5, 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: 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