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[Federal Register Volume 77, Number 142 (Tuesday, July 24, 2012)]
[Notices]
[Pages 43288-43289]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-17924]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10389, CMS-855S and CMS-855(A,B,I,R)]

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 (request 
for a new OMB control number). Title of Information Collection: The 
Home and Community-Based Service (HCBS) Experience Survey. Use: This 
study is a one-time pilot field test involving individuals who receive 
HCBS from Medicaid programs. The field test will be conducted for the 
following purposes: (a) To assess survey methodology--to determine how 
well a face-to-face survey and telephone survey performs with 
individuals who receive HCBS services; (b) Psychometric Analysis--to 
provide information for the revision and shortening of the survey based 
on the assessment of the reliability and construct validity of survey 
items and composites; and (c) Case mix adjustment analysis--to assess 
the variables that may be considered as case mix adjusters. These 
preliminary research activities are not required by regulation, and 
will not be used by CMS to regulate or sanction its customers. They 
will be entirely voluntary and the confidentiality of respondents and 
their responses will be preserved.
    The information collected will be used to revise and test the 
survey instrument described in the Background section of the PRA 
package's Supporting Statement. Within the PRA package, Attachment B 
includes two versions of the survey (one modified for accessibility) 
and Attachment C has the introductory information. The end result will 
be an improvement in information collection instruments and in the 
quality of data collected, a reduction or minimization of respondent 
burden, increased agency efficiency, and improved responsiveness to the 
public. Following the field test, CMS will seek approval from the CAHPS 
consortium for the HCBS Experience Survey to be a new addition to the 
CAHPS[supreg] family of surveys. Form Number: CMS-10389 (OCN 0938-New). 
Frequency: Once. Affected Public: Individuals and Households. Number of 
Respondents: 18,000. Total Annual Responses: 18,000. Total Annual 
Hours: 9,000. (For policy questions regarding this collection contact 
Anita Yuskauskas at 410-786-0268. For all other issues call 410-786-
1326.)
    2. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Medicare 
Enrollment Application--Durable Medical Equipment, Prosthetics, 
Orthotics and Supplies (DMEPOS) Suppliers Use: The primary function of 
the CMS 855S Durable Medical Equipment, Prosthetics, Orthotics and 
Supplies (DMEPOS) supplier enrollment application is to gather 
information from a supplier that tells us who it is, whether it meets 
certain qualifications to be a health care supplier, where it renders 
its services or supplies, the identity of the owners of the enrolling 
entity, and information necessary to establish the correct claims 
payment. The goal of evaluating and revising the CMS 855S DMEPOS 
supplier enrollment application is to simplify and clarify the 
information collection without jeopardizing our need to collect 
specific information. The majority of the revisions contained in this 
submission are non-substantive in nature such as spelling and 
formatting corrections; however, we also removed duplicate fields and 
obsolete questions and provided clarification and simplified the 
instructions for the completing the application. Form Number: CMS-
855(S) (OCN: 0938-1056); Frequency: Yearly; Affected Public: Private 
Sector; Business or other for-profit and not-for-profit institutions; 
Number of Respondents: 43,350; Total Annual Responses: 43,350; Total 
Annual Hours: 113,550 (For policy questions regarding this contact Kim 
McPhillips at 410-786-5374. For all other issues call 410-786-1326.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare 
Enrollment Application Use: The primary function of the CMS-855 
Medicare enrollment application is to gather information from a 
provider or supplier that tells us who it is, whether it meets certain 
qualifications to be a health care provider or supplier, where it 
practices or renders its services, the identity of the owners of the 
enrolling entity, and other information necessary to establish correct 
claims payments. Form Number: CMS-855(A, B, I, R) (OCN: 0938-0685); 
Frequency: Yearly; Affected Public: Private Sector; Business or other 
for-profit and not-for-profit institutions; Number of Respondents: 
440,450; Total Annual Responses: 440,450; Total Annual Hours: 856,395 
(For policy questions regarding this

[[Page 43289]]

contact Kim McPhillips at 410-786-5374. 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 August 23, 2012.

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

    Dated: July 18, 2012.
Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2012-17924 Filed 7-23-12; 8:45 am]
BILLING CODE 4120-01-P
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