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[Federal Register Volume 76, Number 229 (Tuesday, November 29, 2011)]
[Notices]
[Pages 73648-73649]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-30729]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier CMS-29 and CMS-209]

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: Revision of a currently 
approved collection; Title of Information Collection: Request for 
Certification as a Rural Health Clinic Form and Supporting Regulations 
in 42 CFR 491.1-491.11; Use: The Form CMS-29, Request for Certification 
as a Supplier of Rural Health Clinic (RHC) Services under the Medicare/
Medicaid Program, is utilized as an application to be completed by 
suppliers of RHC services requesting participation in the Medicare 
program. This form initiates the process of obtaining a decision as to 
whether the conditions for certification are met as a supplier of RHC 
services. It also promotes data reduction or introduction to and 
retrieval from the Automated Survey Process Environment (ASPEN) and 
related survey and certification databases by the CMS Regional Offices. 
Should any question arise regarding the structure of the organization, 
this information is readily available. With this renewal request, the 
title of the Form CMS-29 is being revised to better describe the 
purpose of the data being collected. Both new and existing clinics must 
provide and attest to the accuracy of specific clinic data as a part of 
the RHC certification process. Therefore, the revised title is ``Form 
CMS-29/Verification of Clinic Data--Rural Health Clinic Program.'' The 
Form CMS-29 is also being revised to remove Section V, Federal Support. 
The information captured under Section V is not a deciding factor as to 
whether or not a clinic meets RHC certification requirements. 
Therefore, it is unnecessary to require facilities to complete this 
section as a part of the certification process; Form Number: CMS-29 
(OCN 0938-0074); Frequency: Occasionally (initially and then every six 
years); Affected Public: Private Sector (Business or other for-profit 
and Not-for-profit institutions); Number of Respondents: 3,981; Total 
Annual Responses: 830; Total Annual Hours: 138. (For policy questions 
regarding this collection contact Shont[eacute] Carter at (410) 786-
3532. For all other issues call (410) 786-1326.)
    2. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
Laboratory Personnel Report (CLIA) and Supporting Regulations in 42 CFR 
493.1357, 493.1363, 493.1405, 493.1406, 493.1411, 493.1417, 493.1423, 
493.1443, 493.1449, 493.1455, 493.1461, 493.1462, 493.1469, 493.1483, 
493.1489 and 493.1491; Use: The information collected on this survey 
form is used in the administrative pursuit of the Congressionally 
mandated program with regard to regulation of laboratories 
participating in CLIA. The surveyor will provide the laboratory with 
the CMS-209 form. While the surveyor performs other aspects of the 
survey, the laboratory will complete the CMS-209 by recording the 
personnel data needed to support their compliance with the personnel 
requirements of CLIA. The surveyor will then use this information in 
choosing a sample of personnel to verify compliance with the personnel 
requirements. Information on personnel qualifications of all technical 
personnel is needed to ensure the sample is representative of the 
entire laboratory; Form Number: CMS-209 (OCN 0938-0151); Frequency: 
Biennially; Affected Public: Private Sector; State, Local, or Tribal 
Governments; and Federal Government; Number of Respondents: 20,486; 
Total Annual Responses: 10,243; Total Annual Hours: 5,121.50. (For 
policy questions regarding this collection contact Kathleen Todd at 
(410) 786-3385. 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

[[Page 73649]]

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.
    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 January 30, 2012:
    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: November 21, 2011.
Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2011-30729 Filed 11-28-11; 8:45 am]
BILLING CODE 4120-01-P
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