78264 Federal Register / Vol. 76, No. 242 / Friday, December 16, 2011 / Notices 

Management Analysis and Services Office, 

CDC, pursuant to Public Law 92–463. 

Matters to be Discussed: The meeting will 

include the initial review, discussion, and 

evaluation of applications received in 

response to ‘‘Occupational Safety and Health 

Training Project Grants, PAR 10–288.’’ 

Contact Person for More Information: 

Bernadine Kuchinski, Ph.D., Scientific 

Review Officer, CDC, Taft Laboratories, 4676 

Columbia Parkway, Mailstop E00, Cincinnati, 

Ohio 45226, Telephone: (513) 533–8253. 

The Director, Management Analysis 

and Services Office, has been delegated 

the authority to sign Federal Register 

notices pertaining to announcements of 

meetings and other committee 

management activities, for both the 

Centers for Disease Control and 

Prevention and the Agency for Toxic 

Substances and Disease Registry. 

Dated: December 6, 2011. 

Elaine L. Baker, 

Director, Management Analysis and Services 

Office, Centers for Disease Control and 

Prevention. 

[FR Doc. 2011–32203 Filed 12–15–11; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–179, CMS–10221, 

CMS–10408, and CMS–R–245] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services. 

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: State Plan 

Under Title XIX of the Social Security 

Act (Base plan pages, Attachments, 

Supplements to attachments); Use: State 

Medicaid agencies complete the plan 

pages and CMS reviews the information 

to determine if the State has met all of 

the provisions that the State has chosen 

to implement. If the requirements are 

met, CMS will approve the amendments 

to the State’s Medicaid plan giving the 

State the authority to implement the 

flexibilities. For a State to receive 

Medicaid Title XIX funding, there must 

be an approved Title XIX State plan; 

Form Number: CMS–179 (OCN 0938– 

0193); Frequency: Occasionally; 

Affected Public: State, Local, or Tribal 

Governments; Number of Respondents: 

56; Total Annual Responses: 1,120; 

Total Annual Hours: 400. (For policy 

questions regarding this collection 

contact Candice Payne at (410) 786– 

4453. For all other issues call (410) 786– 

1326.) 

2. Type of Information Collection 

Request: Reinstatement without change 

of a previously approved collection ; 

Title of Information Collection: 

Worksheet for Recording Results of 

Medicare Site Visits of Independent 

Diagnostic Testing Facilities (IDTFs); 

Use: The worksheet (form) was 

developed, approved by the Office of 

Management and Budget, and 

implemented to provide CMS with a 

standard format to collect and verify 

information regarding the compliance of 

IDTFs with the performance standards 

found in 42 CFR 410.33(g). This 

previously approved form was allowed 

to expire in error. CMS is now seeking 

to reinstate the use of this form. 

The worksheet is used to collect and 

record information obtained on IDTF 

site visits; the data collected during site 

visits facilitates the verification of the 

accuracy and completeness of the 

information the IDTF furnished on its 

CMS–855B enrollment application. The 

worksheet is completed by CMS or its 

contractors. Some of the answers to the 

questions/data elements on the 

worksheet are verbally furnished by the 

IDTF during the site visit; Form 

Number: CMS–10221 (OCN 0938–1029); 

Frequency: Occasionally; Affected 

Public: Private Sector (Business or other 

for-profits); Number of Respondents: 

2,000; Total Annual Responses: 2,000; 

Total Annual Hours: 4,000. (For policy 

questions regarding this collection 

contact Michael Collett at (410) 786– 

6121. For all other issues call (410) 786– 

1326.) 

3. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Early Retiree 

Reinsurance Program Survey of Plan 

Sponsors; Use: Under the Patient 

Protection and Affordable Care Act (42 

U.S.C. 18002) and implementing 

regulations at 45 CFR part 149, 

employment-based plans that offer 

health coverage to early retirees and 

their spouses, surviving spouses, and 

dependents are eligible to receive taxfree reimbursement for a portion of the 

costs of health benefits provided to such 

individuals. The statute limits how the 

reimbursement funds can be used, and 

requires the Secretary of HHS to 

develop a mechanism to monitor the 

appropriate use of such funds. The 

survey that is the subject of this PRA 

package is part of that mechanism; Form 

Number: CMS–10408 (OMB 0938– 

1150); Frequency: Yearly; Affected 

Public: Private Sector (Business or other 

for-profit and Not-for-profit 

institutions); Number of Respondents: 

2,076; Total Responses: 2,076; Total 

Hours: 22,836. (For policy questions 

regarding this collection contact David 

Mlawsky at (410) 786–6851. For all 

other issues call (410) 786–1326.) 

4. Type of Information Collection 

Request: Extension without change of a 

currently approved collection; Title of 

Information Collection: Medicare and 

Medicaid Programs OASIS Collection 

Requirements as Part of the CoPs for 

HHAs and Supp. Regs. in 42 CFR 48.55, 

484.205, 484.245, 484.250; Use: This 

data set is currently mandated for use by 

Home Health Agencies (HHAs) as a 

condition of participation (CoP) in the 

Medicare program. Since 1999, the 

Medicare CoPs have mandated that 

HHAs use the OASIS data set when 

evaluating adult non-maternity patients 

receiving skilled services. The OASIS is 

a core standard assessment data set that 

agencies integrate into their own 

patient-specific, comprehensive 

assessment to identify each patient’s 

need for home care that meets the 

patient’s medical, nursing, 

rehabilitative, social, and discharge 

planning needs; Form Number: CMS–R– 

245 (OCN 0938–0760); Frequency: 

Occasionally; Affected Public: Private 

Sector (Business or other for-profit and 

Not-for-profit institutions); Number of 

Respondents: 11,495; Total Annual 

Responses: 16,476,008; Total Annual 

Hours: 16,567,968. (For policy questions 

regarding this collection contact Robin 

Dowell at (410) 786–0060. 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 


jlentini on DSK4TPTVN1PROD with NOTICES
Federal Register / Vol. 76, No. 242 / Friday, December 16, 2011 / Notices 78265 

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. 

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 14, 2012: 

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 9, 2011. 

Martique Jones, 

Director, Regulations Development Group, 

Division B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2011–32296 Filed 12–15–11; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–10412] 

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: New collection; Title of 

Information Collection: Section 1115 

Demonstration: Long Term Services and 

Supports (LTSS) and Other Service 

Models for Individuals with Disabilities 

and Chronic Conditions; Use: Section 

1115 of the Social Security Act provides 

the Secretary of Health and Human 

Services broad authority to authorize 

experimental, pilot, or demonstration 

projects likely to assist in promoting the 

objectives of the Medicaid statute. 

Flexibility under Section 1115 is 

sufficiently broad to allow States to test 

substantially new ideas of policy merit. 

States seeking interventions for 

individuals needing LTSS to lower 

costs, improve care and improve health 

can utilize the 1115 demonstration to 

test and deliver innovative services and 

approaches to better and more 

efficiently meet the needs of this 

population. Section 1115 

demonstrations provide a vehicle for 

innovations in both care delivery and 

payment methodologies. 

Demonstrations must be ‘‘budget 

neutral’’ over the life of the project, 

meaning they cannot be expected to cost 

the Federal government more than it 

would cost without the waiver. State 

Medicaid agencies are responsible for 

developing section 1115 demonstration 

applications and submitting them to 

CMS; Form Number: CMS–10412 (OCN: 

0938–New); Frequency: Once; Affected 

Public: State, Local, or Tribal 

Governments; Number of Respondents: 

56; Total Annual Responses: 56; Total 

Annual Hours: 2,240. (For policy 

questions regarding this collection 

contact Adrienne Delozer at (410) 786– 

0278. 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 January 17, 2012. 

OMB, Office of Information and 

Regulatory Affairs, Attention: CMS 

Desk Officer, Fax Number: (202) 395– 

6974, Email: 

OIRA_submission@omb.eop.gov. 

Dated: December 9, 2011. 

Martique Jones, 

Director, Regulations Development Group, 

Division-B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2011–32294 Filed 12–15–11; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–10180, CMS–R– 

199, CMS–10379 and CMS–10418] 

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: Extension of a currently 

approved collection; Title of 

Information Collection: Children’s 

Health Insurance Program (CHIP) Report 

on Payables and Receivables; Use: 

Collection of CHIP data and the 

calculation of the CHIP Incurred But 

Not Reported (IBNR) estimate are 

pertinent to CMS’ financial audit. The 

CFO auditors have reported the lack of 

an estimate for CHIP IBNR payables and 

receivables as a reportable condition in 

the FY 2005 audit of CMS’s financial 

statements. It is essential that CMS 


jlentini on DSK4TPTVN1PROD with NOTICES