```

[Federal Register Volume 77, Number 75 (Wednesday, April 18, 2012)]
[Notices]
[Pages 23265-23266]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-9259]

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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier CMS-668B, CMS-1557 and CMS-10399]

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 23266]]

Information Collection: Post Clinical Laboratory Survey Questionnaire 
and Supporting Regulations in 42 CFR 493.1771, 493.1773, and 493.1777. 
Use: Form CMS-668B is used by a Clinical Laboratory Improvement 
Amendments (CLIA) laboratory to express its satisfaction with the 
survey process and to make recommendations for improvement. Surveyors 
furnish this form to all laboratories that receive either an onsite 
survey or the Alternate Quality Assessment Survey (i.e., paper survey 
of quality indicators). CMS Central Office performs an overview 
evaluation of the completed forms. Each calendar year, a summary of the 
information collected is sent to the State and CMS Regional Office. 
Form Number: CMS-668B (OCN 0938-0653). Frequency: Biennially; Affected 
Public: Business or other for-profits and not-for-profit institutions. 
State, Local, or Tribal Government, Federal Government. Number of 
Respondents: 21,000. Total Annual Responses: 10,500. Total Annual 
Hours: 2,625. (For policy questions regarding this collection contact 
Kathleen Todd at 410-786-3385. For all other issues call 410-786-1326.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection. Title of Information Collection: Survey Report 
Form for Clinical Laboratory Improvement Amendments (CLIA) and 
Supporting Regulations in 42 CFR 493.1-493.2001. Use: CMS 1557 is used 
to report surveyor findings during a CLIA survey. For each type of 
survey conducted (i.e., initial certification, recertification, 
validation, complaint, addition/deletion of specialty/subspecialty, 
transfusion fatality investigation, or revisit inspections) the Survey 
Report Form incorporates the requirements specified in the CLIA 
regulations. Form Number: CMS-1557 (OCN 0938-0544). Frequency: 
Biennially. Affected Public: Business or other for-profit, Not-for-
profit institutions, State, Local or Tribal Governments and Federal 
Government. Number of Respondents: 21,000. Total Annual Responses: 
10,500. Total Annual Hours: 5,248. (For policy questions regarding this 
collection contact Kathleen Todd at 410-786-3385. For all other issues 
call 410-786-1326.)
    3. Type of Information Collection Request: New collection; Title of 
Information Collection: Analysis of Transportation Barriers to 
Utilization of Medicare Services by American Indian and Alaska Native 
Medicare Beneficiaries; Use: The purpose of the proposed study is to 
identify and analyze transportation barriers associated with the 
utilization of Medicare services by American Indian and Alaska Native 
(AI/AN) beneficiaries, to identify and analyze the health outcomes 
resulting from those barriers, and ultimately to identify potential 
solutions that could help mitigate the problem and produce meaningful 
improvements in health care use and health outcomes for this 
population. Specifically, the information that will be collected 
through the use of instruments and the study developed under the 
Analysis of Transportation Barriers to Utilization of Medicare Services 
by American Indian and Alaska Native Medicare Beneficiaries Project has 
not been collected or evaluated previously by any agency or individual, 
so data on the extent of transportation barriers for rural AI/AN 
beneficiaries to Medicare services by AI/AN Medicare beneficiaries are 
not available except from the proposed data collection activity.
    The information gathered as part of the project--through the use of 
survey, interview, and focus group instruments--will be used by CMS to 
identify transportation barriers to Medicare services for AI/AN 
Medicare beneficiaries. It will provide the first ever complete 
evaluation of transportation barriers to health care for this 
population.
    The information collection request has been revised since the 
publication of the 60-day Federal Register notice. Several questions 
were added in response to public comments. In addition to new 
questions, several clarifying edits were made as well. Form Number: 
CMS-10399 (OMB  0938-NEW); Frequency: Occasionally; Affected 
Public: Individuals and Households, Private Sector; Number of 
Respondents: 3,418; Total Annual Responses: 3,418; Total Annual Hours: 
2,544. (For policy questions regarding this collection contact Roger 
Goodacre at 410-786-3209. 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 May 18, 2012.

OMB, Office of Information and Regulatory Affairs,
Attention: CMS Desk Officer,
Fax Number: (202) 395-6974,
Email: OIRA_submission@omb.eop.gov.

    Dated: April 12, 2012.
Martique Jones,
Director, Regulations Development Group, Division-B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2012-9259 Filed 4-17-12; 8:45 am]
BILLING CODE 4120-01-P
```