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[Federal Register Volume 75, Number 242 (Friday, December 17, 2010)]
[Notices]
[Pages 78999-79000]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-31599]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-18F5 and CMS-R-26]

Agency Information Collection Activities: Submission for OMB 
Review; 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), 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: Extension of a currently 
approved collection; Title of Information Collection: Application for 
Hospital Insurance; Use: Individuals who are not entitled to or 
eligible for railroad retirement board (RRB) or Social Security 
Administration benefits must file an application for Part A. This group 
includes individuals who defer filing an application for monthly 
benefits, individuals who are transitionally insured, government 
employees who pay only the Hospital Insurance portion of the Federal 
Insurance Contributions Act tax and individuals eligible for Premium 
Part A for the Working Disabled. The Application for Hospital 
Insurance-CMS-18F5 was designed to capture all the information needed 
to make a determination of an individual's

[[Page 79000]]

entitlement to Part A and Supplementary Medical Insurance (Part B). 
Form Number: CMS-18F5 (OMB: 0938-0251); Frequency: Once; 
Affected Public: Individuals or households; Number of Respondents: 
50,000; Total Annual Responses: 50,000; Total Annual Hours: 12,495. 
(For policy questions regarding this collection contact Naomi Rappaport 
at 410-786-2175. For all other issues call 410-786-1326.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Clinical 
Laboratory Improvement Amendment (CLIA) of 1988 and Supporting 
Regulations in 42 CFR 493.1-.2001; Use: The information collection 
requirements in 42 CFR part 493 outline the requirements necessary to 
determine an entity's compliance with CLIA. CLIA requires laboratories 
that perform testing on human beings to meet performance requirements 
(quality standards) in order to be certified by the Department of 
Health and Human Services (DHHS). DHHS conducts inspections to 
determine a laboratory's compliance with CLIA requirements. CLIA 
implements the certificate, laboratory standards and inspection 
requirements; Form Number: CMS-R-26 (OMB: 0938-0612); 
Frequency: Occasionally; Affected Public: Federal Government; State, 
Local, or Tribal Governments; Private Sector: Business or other for-
profits and not-for-profit institutions; Number of Respondents: 
168,688; Total Annual Responses: 756,240; Total Annual Hours: 
11,363,280. (For policy questions regarding this collection contact 
Raelene Perfetto at 410-786-6876. 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 
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.
    To be assured consideration, comments and recommendations for the 
proposed information collections must be received by the OMB desk 
officer at the address below, no later than 5 p.m. on January 18, 2011.
    OMB, Office of Information and Regulatory Affairs, Attention: CMS 
Desk Officer, Fax Number: (202) 395-6974. E-mail: OIRA_submission@omb.eop.gov.

    Dated: December 10, 2010.
Martique Jones,
Director, Regulations Development Division-B, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2010-31599 Filed 12-16-10; 8:45 am]
BILLING CODE 4120-01-P
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