25266 Federal Register / Vol. 75, No. 88 / Friday, May 7, 2010 / Notices 

Written comments and 

recommendations concerning the 

proposed information collection should 

be sent by June 7, 2010 to: SAMHSA 

Desk Officer, Human Resources and 

Housing Branch, Office of Management 

and Budget, New Executive Office 

Building, Room 10235, Washington, DC 

20503; due to potential delays in OMB’s 

receipt and processing of mail sent 

through the U.S. Postal Service, 

respondents are encouraged to submit 

comments by fax to: 202–395–6974. 

Dated: April 28, 2010. 

Elaine Parry, 

Director, Office of Program Services. 

[FR Doc. 2010–10907 Filed 5–6–10; 8:45 am] 

BILLING CODE 4162–20–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–901A and 901D] 

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: Extension of a currently 

approved collection; Title of 

Information Collection: Federal 

Qualification Application (42 CFR 

417.140) and Medicare Health Care 

Prepayment Plan Application (42 CFR 

417.800); Use: The application is the 

collection form used to obtain 

information to determine if an applicant 

meets the regulatory requirements to 

enter into a contract with CMS as a 

Federal Qualified health maintenance 

organization (HMO) or to provide health 

benefits to Medicare beneficiaries as a 

Medicare Health Care Prepayment Plan 

contractor. Form Number: CMS–901A & 

901D (OMB#: 0938–0470); Frequency: 

Once; Affected Public: Business or other 

for-profits and Not-for-profit 

institutions; Number of Respondents: 

20; Total Annual Responses: 20; Total 

Annual Hours: 800 (For policy 

questions regarding this collection 

contact Heidi Arndt at 410–786–1607. 

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 

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 on (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 July 6, 2010: 

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. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2010–10623 Filed 5–6–10; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

[Document Identifier: CMS–10293] 

Centers for Medicare & Medicaid 

Services; Agency Information 

Collection Activities: Submission for 

OMB Review; 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), 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; Title of 

Information Collection: Tribal 

Consultation State Plan Amendment 

Template; Use: Effective July 1, 2009, 

section 5006 of the American Recovery 

and Reinvestment Act of 2009 (Recovery 

Act) amended section 1902(a)(73) of the 

Act to require that certain States utilize 

a process for the State to seek advice on 

a regular, ongoing basis from designees 

of the Indian Health Service (IHS) and 

Urban Indian Organizations concerning 

Medicaid and Children’s Health 

Insurance Program (CHIP) matters 

having a direct effect on them. The 

consultation process is required for the 

37 States in which 1 or more Indian 

Health Programs or Urban Indian 

Organizations furnish health care 

services. The State Medicaid agency for 

each of these States will complete the 

template page and submit it for approval 

as part of a State plan amendment, to 

document how it meets the 

requirements for tribal consultation. 

Form Number: CMS–10293 (OMB#: 

0938–NEW); Frequency: Reporting— 

Once and occasionally; Affected Public: 

State, Local, or Tribal Governments; 

Number of Respondents: 37; Total 

Annual Responses: 37; Total Annual 

Hours: 37. (For policy questions 

regarding this collection contact Lane 

Terwilliger at 410–786–2059. 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 


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