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[Federal Register Volume 76, Number 63 (Friday, April 1, 2011)]
[Notices]
[Pages 18222-18223]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-7746]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier CMS-265-11, CMS-381, and CMS-10123 and 10124]

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: Independent Renal 
Dialysis Facility Cost Report; Use: The Independent Renal Dialysis 
Facility Cost Report, is filed annually by providers participating in 
the Medicare program to identify the specific items of cost and 
statistics of facility operation that independent renal dialysis 
facilities are required to report. The forms are revised in accordance 
with the End-Stage Renal Disease Prospective Payment System Final Rule 
published August 12, 2010 which implemented statutory requirements of 
the Medicare Improvements for Patients and Providers Act (MIPPA), 
enacted July 15, 2008. Additionally, the forms are revised to 
incorporate data previously reported on the Provider Cost Report 
Reimbursement Questionnaire, Form CMS-339. Form Number: CMS-265-94 
(OMB: 0938-0236); Frequency: Yearly; Affected Public: Business 
or other for-profits and Not-for-profit institutions; Number of 
Respondents: 5,654 Total Annual Responses: 5,654; Total Annual Hours: 
367,510 (For policy questions regarding this collection contact Gail 
Duncan at 410-786-7278. For all other issues call 410-786-1326.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Identification of 
Extension Units of Medicare Approved Outpatient Physical Therapy/
Outpatient Speech Pathology (OPT/OSP) Providers and Supporting 
Regulations in 42 CFR 485.701-485.729; Use: The collected information 
is used in conjunction with 42 CFR 485.701 through 485.729 governing 
the operation of providers of outpatient physical therapy and speech-
language pathology services. The provider uses the form to report to 
the State survey agency extension locations that it has added since the 
date of last report. The form is used by the State survey agencies and 
by the CMS regional offices to identify and monitor extension locations 
to ensure their compliance with the Federal requirements for the 
providers of outpatient physical therapy and speech-language pathology 
services; Form Number: CMS-381 (OMB : 0938-0273); Frequency: 
Annually; Affected Public: Private Sector; Business or other for-profit 
and not-for-profit institutions; Number of Respondents: 2,960; Total 
Annual Responses: 2,960; Total Annual Hours: 740. (For policy questions 
regarding this collection contact Georgia Johnson at 410-786-6859. For 
all other issues call 410-786-1326.)
    3. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Notice of 
Provider Non-Coverage (CMS-10123) and Detailed Explanation of Non-
Coverage (CMS-10124); Use: The Notice of Medicare Provider Non-Coverage 
(CMS-10123) is used to inform fee-for-service Medicare beneficiaries of 
the determination that their provider services will end, and of their 
right to an expedited review of that determination. The Detailed 
Explanation of Non-Coverage (CMS-10124) is used to provide 
beneficiaries who request an expedited determination with detailed 
information of why the services should end. The revised Notice of 
Provider Non-Coverage and Detailed Explanation of Provider Non-Coverage 
will no longer require use of the beneficiary's Medicare number as a 
patient identifier. Instead, when applicable, providers may use a 
number that helps to link the notice with a related claim. Form Number: 
CMS-10123 and 10124 (OMB 0938-0953); Frequency: Occasionally; 
Affected Public: Business or other for-profit, not-for-profit 
institutions, and Individuals or households; Number of Respondents:

[[Page 18223]]

5,314,164; Total Annual Responses: 5,314,194; Total Annual Hours: 
885,699.
    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.hhs.gov/PaperworkReductionActof1995, 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 May 31, 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: March 25, 2011.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 2011-7746 Filed 3-31-11; 8:45 am]
BILLING CODE 4120-01-P
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