[Federal Register Volume 72, Number 12 (Friday, January 19, 2007)]
[Notices]
[Pages 2532-2533]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-700]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10176]


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: New Collection; Title of 
Information Collection: Governmental Status of Health Care Provider 
Form; Use: The questions presented on the ``Governmental Status of 
Health Care Provider'' form are required for CMS to be able to 
determine the permissibility of State funding sources associated with 
selected reimbursement-related State Plan Amendments. Without the 
information gathered on this form, CMS will not be able to determine 
the State's compliance with Section 1902(a)(30)(A) or Section 1903(w) 
of the Social Security Act. If CMS cannot determine compliance, CMS 
cannot approve the State Plan Amendments, resulting in potential harm 
to Medicaid beneficiaries. The respondents of this information request 
will be the State's State Medicaid Agency. Form Number: CMS-10176 
(OMB<greek-i>: 0938-NEW); Frequency: Reporting: Once and on occasion; 
Affected Public: State, Local, or Tribal Governments; Number of 
Respondents: 50; Total Annual Responses: 4,000; Total Annual Hours: 
4,000.
    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 e-mail your request, including your address, phone number, OMB 
number, and CMS document identifier, to <a href="/cdn-cgi/l/email-protection#4b1b2a3b2e393c2439200b28263865232338652c243d"><span class="__cf_email__" data-cfemail="194978697c6b6e766b72597a746a3771716a377e766f">[email protected]</span></a>, 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 at the address below, 
no later than 5 p.m. on March 20, 2007.


[[Page 2533]]


CMS, Office of Strategic Operations and Regulatory Affairs, Division of 
Regulations Development--A, Attention: Melissa Musotto, Room C4-26-05, 
7500 Security Boulevard, Baltimore, MD 21244-1850.

    Dated: January 12, 2007.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
 [FR Doc. E7-700 Filed 1-18-07; 8:45 am]
BILLING CODE 4120-01-P


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