```

[Federal Register Volume 76, Number 98 (Friday, May 20, 2011)]
[Notices]
[Page 29248]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-12472]

-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-R-235]

Agency Information Collection Activities: Proposed Collection; 
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) 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: Revision of a currently 
approved collection; Title of Information Collection: Data Use 
Agreement (DUA) for Data Acquired from the Centers for Medicare & 
Medicaid Services (CMS); Use: The Privacy Act of 1976, Sec.  552a 
requires the Centers for Medicare & Medicaid Services (CMS) to track 
all disclosures of the agency's Personally Identifiable Information 
(PII) and the exceptions for these data releases. CMS is also required 
by the Health Insurance Portability and Accountability Act (HIPAA) of 
1996 and the Federal Information Security Management Act (FISMA) of 
2002 to properly protect all PII data maintained by the agency. When 
entities request CMS PII data, they enter into a Data Use Agreement 
(DUA) with CMS. The DUA stipulates that the recipient of CMS PII data 
must properly protect the data according to FISMA and also provide for 
its appropriate destruction at the completion of the project/study or 
the expiration date of the DUA. The DUA form enables the data recipient 
and CMS to document the request and approval for release of CMS PII 
data. The form requires the submitter to provide the Requestor's 
organization; project/study name; CMS contract number (if applicable); 
data descriptions and the years of the data; retention date; 
attachments to the agreement; name, title, contact information to 
include address, city, state, zip code, phone, e-mail, signature and 
date signed by the requester and custodian; disclosure provision; name 
of Federal Agency sponsor; Federal Representative name, title, contact 
information, signature, date; CMS representative name, title, contact 
information, signature and date; and concurrence/non-concurrence 
signatures and dates from 3 CMS System Manager or Business Owners. 
While the data elements collected are not subject to change, the 
individualized clauses that are incorporated into any specific DUA are 
subject to change based on a specific case or situation such as 
disclosures to states, oversight agencies or DUAs for disproportionate 
share hospital (DSH) data requests as well as updates to DUAs with 
additional data descriptions, changes to the requestor or adding 
custodians to current DUAs. Form Number: CMS-R-235 (OCN: 0938-0734) 
Frequency: Once; Affected Public: Private Sector--Business or other 
For-profits and Not-for-profit Institutions; Number of Respondents: 
2,200; Number of Responses: 2,200; Total Annual Hours: 916. (For policy 
questions regarding this collection, contact Sharon Kavanagh at 410-
786-5441. 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.gov/PaperworkReductionActof1995/PRAL/list.asp#TopOfPage 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 at 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 July 19, 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: May 17, 2011.
Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2011-12472 Filed 5-19-11; 8:45 am]
BILLING CODE 4120-01-P
```