```

[Federal Register Volume 79, Number 110 (Monday, June 9, 2014)]
[Notices]
[Pages 32962-32963]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-13193]

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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-1856 and CMS-1893, CMS-10068 and CMS-265-11]

Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services, HHS.

ACTION: Notice.

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

SUMMARY: The Centers for Medicare & Medicaid Services (CMS) is 
announcing an opportunity for the public to comment on CMS' intention 
to collect information from the public. Under the Paperwork Reduction 
Act of 1995 (the PRA), federal agencies are required to publish notice 
in the Federal Register concerning each proposed collection of 
information (including each proposed extension or reinstatement of an 
existing collection of information) and to allow 60 days for public 
comment on the proposed action. Interested persons are invited to send 
comments regarding our burden estimates 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.

DATES: Comments must be received by August 8, 2014.

ADDRESSES: When commenting, please reference the document identifier or 
OMB control number (OCN). To be assured consideration, comments and 
recommendations must be submitted in any one of the following ways:
    1. Electronically. You may send 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) that are 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.
    To obtain copies of a supporting statement and any related forms 
for the proposed collection(s) summarized in this notice, you may make 
your request using one of following:
    1. Access CMS' Web site address at http://www.cms.hhs.gov/PaperworkReductionActof1995.
    2. Email your request, including your address, phone number, OMB 
number, and CMS document identifier, to Paperwork@cms.hhs.gov.
    3. Call the Reports Clearance Office at (410) 786-1326.

FOR FURTHER INFORMATION CONTACT: Reports Clearance Office at (410) 786-
1326.

SUPPLEMENTARY INFORMATION: 

Contents

    This notice sets out a summary of the use and burden associated 
with the following information collections. More detailed information 
can be found in each collection's supporting statement and associated 
materials (see ADDRESSES).

CMS-1856 and CMS-1893 Request for Certification in the Medicare and/or 
Medicaid Program to Provide Outpatient Physical Therapy and/or Speech 
Pathology Services, and Outpatient Physical Therapy--Speech Pathology 
Survey Report

CMS-10068 Medicare Ombudsman Customer Service Feedback Survey

CMS-265-11 Independent Renal Dialysis Facility Cost Report Form

    Under the Paperwork Reduction Act (PRA) (44 U.S.C. 3501-3520), 
Federal agencies must obtain approval from the Office of Management and 
Budget (OMB) for each collection of information they conduct or 
sponsor. The term ``collection of information'' is defined in 44 U.S.C. 
3502(3) and 5 CFR 1320.3(c) and includes agency requests or 
requirements that members of the public submit reports, keep records, 
or provide information to a third party. Section 3506(c)(2)(A) of the 
PRA requires Federal agencies to publish a 60-day notice in the Federal 
Register concerning each proposed collection of information, including 
each proposed extension or reinstatement of an existing collection of 
information, before submitting the collection to OMB for approval. To 
comply with this requirement, CMS is publishing this notice.
    Information Collection
    1. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: (CMS-1856) 
Request for Certification in the Medicare and/or Medicaid Program to 
Provide Outpatient Physical Therapy and/or Speech Pathology Services, 
and (CMS-1893) Outpatient Physical Therapy--Speech Pathology Survey 
Report; Use: Form CMS-1856 is used as an application to be completed by 
providers of outpatient physical therapy and/or speech-language 
pathology services requesting participation in the Medicare and 
Medicaid programs. This form initiates the process for obtaining a 
decision as to whether the conditions of participation are met as a 
provider of outpatient physical therapy, speech-language pathology 
services, or both. It is used by the State agencies to enter new 
providers into the Automated Survey Process Environment (ASPEN). Form 
CMS-1893 is used by the State survey agency to record data collected 
during an on-site survey of a provider of outpatient physical therapy 
and/or speech-language pathology services, to determine compliance with 
the applicable conditions of participation, and to report this 
information to the Federal government. The form is primarily a coding 
worksheet designed to facilitate data reduction and retrieval into the 
ASPEN system. The information needed to make certification decisions is 
available to us only through the use of information abstracted from the 
form.
    Form Numbers: CMS-1856 and CMS-1893 (OMB control number: 0938-
0065); Frequency: Annually, occasionally; Affected Public: Private 
sector--Business or other for-profit and Not-for-profit institutions; 
Number of Respondents: 700; Total Annual Responses: 700; Total Annual 
Hours: 613. (For policy questions regarding this collection contact 
James Cowher at 410-786-1948.)
    2. Type of Information Collection Request: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: Medicare Ombudsman Customer Service Feedback Survey; Use: 
The Centers for Medicare and Medicaid Services stresses a continuing 
need for setting

[[Page 32963]]

customer service goals that include providing accurate, timely, and 
relevant information to its customers. With these goals in mind, we 
periodically survey our customers to ensure that the needs of Medicare 
beneficiaries are being met. This survey will be used to measure 
overall satisfaction of the customer service that the Medicare 
Ombudsman Group (MOG) within CMS provides to Medicare beneficiaries and 
their representatives. The information provided will be used by 
management and staff to measure and improve the quality and timeliness 
of responses to written and verbal correspondence.
    Form Numbers: CMS-10068 (OMB control number: 0938-0894); Frequency: 
Annually, occasionally; Affected Public: Private Sector; Business or 
other for-profit and not-for-profit institutions; Number of 
Respondents: 2,380; Total Annual Responses: 2,380; Total Annual Hours: 
317. (For policy questions regarding this collection contact Nancy Conn 
at 410-786-8374.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Independent Renal 
Dialysis Facility Cost Report Form; Use: Providers of services 
participating in the Medicare program are required under sections 
1815(a) and 1861(v)(1)(A) of the Social Security Act (42 U.S.C. 1395g) 
to submit annual information to achieve settlement of costs for health 
care services rendered to Medicare beneficiaries. In addition, 
regulations at 42 CFR 413.20 and 413.24 require adequate cost data and 
cost reports from providers on an annual basis. The Independent Renal 
Dialysis Facility Cost Report (Form CMS-265-11) cost report is needed 
to determine a provider's reasonable costs incurred in furnishing 
medical services to Medicare beneficiaries. The cost reports are 
required to be filed with the provider's Medicare Administrative 
Contractor (MAC). The functions of the MAC are described in section 
1816 of the Social Security Act. However, the collection of data is a 
secondary function of the cost report. We use the data to support 
program operations, payment refinement activities, and to make Medicare 
Trust Fund projections.
    Form Numbers: CMS-10068 (OMB control number: 0938-0894); Frequency: 
Annually, occasionally; Affected Public: Private Sector; Business or 
other for-profit and not-for-profit institutions; Number of 
Respondents: 2,380; Total Annual Responses: 2,380; Total Annual Hours: 
317. (For policy questions regarding this collection contact Gail 
Duncan at 410-786-7278.)

    Dated: June 3, 2014.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2014-13193 Filed 6-6-14; 8:45 am]
BILLING CODE 4120-01-P
```