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[Federal Register Volume 77, Number 170 (Friday, August 31, 2012)]
[Notices]
[Pages 53203-53204]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-21593]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier CMS-359 and CMS-360]

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 without change 
of a currently approved collection. Title of Information Collection: 
Comprehensive Outpatient Rehabilitation Facility (CORF) Eligibility and 
Survey Forms. Use: CMS-359 serves as the application for facilities 
wishing to participate in the Medicare/Medicaid program as CORFs. The 
form initiates the process for obtaining a decision as to whether the 
conditions of participation are met. It also promotes data reduction 
(key punching) or introduction to and retrieval from the Medicare/
Medicaid Automated Certification System, ASPEN, by the CMS Regional 
Offices. Should any question arise regarding the structure of the 
organization, this information is readily available without going 
through the process of completing the form again.
    CMS-360 is used by the State survey agency to record data collected 
to determine provider compliance with individual conditions of 
participation and to report it to the federal government. CMS has the 
responsibility and authority for certification decisions which are 
based on provider compliance with the conditions of participation. The 
information needed to make these decisions is available to CMS only 
through the information abstracted from the survey checklists. The form 
is primarily a worksheet designed to facilitate key punching into ASPEN 
by the state agency after the survey is completed. Form Number: CMS-359 
(CORF Eligibility Form) and CMS-360 (CORF Survey Report Form); (OCN 
0938-0267); Frequency: Occasionally. Affected Public: Private Sector 
(Business or other for-profits). Number of Respondents: 295. Total 
Annual Responses: 42. Total Annual Hours: 137. (For policy questions 
regarding this collection contact Georgia Johnson at 410-786-6859. 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 October 1, 2012. 
OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk 
Officer, Fax Number: (202) 395-6974, Email: OIRA_submission@omb.eop.gov.

[[Page 53204]]

    Dated: August 28, 2012.
Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2012-21593 Filed 8-30-12; 8:45 am]
BILLING CODE 4120-01-P
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