20402 Federal Register / Vol. 77, No. 65 / Wednesday, April 4, 2012 / Notices 

important to explain variability in 

success rates across ART programs and 

across individuals. Data elements and 

definitions currently in use reflect 

CDC’s consultations with 

representatives of the Society for 

Assisted Reproductive Technology 

(SART), the American Society for 

Reproductive Medicine, and RESOLVE: 

the National Infertility Association (a 

national, nonprofit consumer 

organization), as well as a variety of 

individuals with expertise and interest 

in this field. 

Respondents are the 484 ART 

programs in the United States. 

Approximately 440 clinics are expected 

to report an average of 339 ART cycles 

each. Ten percent of responding clinics 

will be randomly selected to participate 

in full validation of selected ART cycle 

records and an abbreviated validation of 

selected ART cycle records. All 

information is collected electronically. 

Respondents have the option of entering 

data directly into a Web-based National 

ART Surveillance System (NASS) 

interface or of transmitting systemcompatible files extracted from other 

record systems. The ART program 

reporting system allows CDC to publish 

an annual report to Congress as 

specified by the FCSRCA and to provide 

information needed by consumers. 

CDC, the data collection contractor, 

and partner organizations engage in 

ongoing dialogue to identify 

opportunities for improvement in 

NASS. During the period of this 

Revision request, minor changes to 

NASS data definitions or similar 

technical adjustments may be proposed 

through the Change Request 

mechanism. 

Starting with 2012 data reporting 

year, CDC plans to implement a brief, 

one-time optional feedback survey to 

clinics for each reporting year. The 

purpose of this survey is to obtain 

insight into NASS usability issues as 

well as respondents’ perspectives on the 

usefulness of the information collected. 

There are no costs to respondents 

other than their time. 

ESTIMATED ANNUALIZED BURDEN HOURS

Respondents Form name Number of 

respondents 

Number of 

responses per 

respondent 

Average 

burden per 

response 

(in hours) 

Total burden 

(in hours) 

ART Programs .................................. NASS ................................................ 440 339 39/60 96,954 

Feedback Survey ............................. 176 1 2/60 6 

Total ........................................... ........................................................... ........................ ........................ ........................ 96,960 

Dated: March 29, 2012. 

Ron A. Otten, 

Director, Office of Scientific Integrity, Office 

of the Associate Director for Science (OADS), 

Office of the Director, Centers for Disease 

Control and Prevention. 

[FR Doc. 2012–8067 Filed 4–3–12; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–855(O)] 

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: Revision of a currently 

approved collection; Title of 

Information Collection: Medicare 

Registration Application; Use: The CMS 

855O allows a physician to receive a 

Medicare identification number 

(without being approved for billing 

privileges) for the sole purpose of 

ordering and referring Medicare 

beneficiaries to Medicare approved 

providers and suppliers. This new 

Medicare registration application form 

allows physicians who do not provide 

services to Medicare beneficiaries to be 

given a Medicare identification number 

without having to supply all the data 

required for the submission of Medicare 

claims. It also allows the Medicare 

program to identify ordering and 

referring physicians without having to 

validate the amount of data necessary to 

determine claims payment eligibility 

(such as banking information), while 

continuing to identify the physician’s 

credentials as valid for ordering and 

referring purposes. Since the physicians 

and non-physician practitioners 

submitting this application are not 

enrolling in Medicare to submit claims 

but are only registering with Medicare 

as eligible to order and refer, CMS 

believes changing the title from 

Medicare Enrollment Application to 

Medicare Registration Application 

better captures the actual purpose of 

this form. 

Where appropriate, CMS has changed 

all references to enrollment or enrolling 

to registration and registering and 

Medicare billing number to National 

Provider Identifier. CMS also added a 

check box to allow physicians and nonphysician practitioners to withdraw 

from the ordering and referring registry. 

A section to collect information on 

professional certifications was added for 

those practitioners who are not 

professionally licensed. Editorial and 

formatting corrections were made in 

response to prior comments received 

during the approval of the current 

version of this application. Other minor 

editorial and formatting corrections 

were made to better clarify the purpose 

of this application. Form Number: 

CMS–855(O) (OCN: 0938–1135); 

Frequency: Occasionally; Affected 

Public: Individuals; Number of 

Respondents: 48,500; Total Annual 

Responses: 48,500; Total Annual Hours: 

24,125. (For policy questions regarding 

this collection contact Kimberly 

McPhillips at 410–786–5374. For all 

other issues call 410–786–1326.) 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 


emcdonald on DSK29S0YB1PROD with NOTICES
Federal Register / Vol. 77, No. 65 / Wednesday, April 4, 2012 / Notices 20403 

Information Collection: Medicare 

Enrollment Application; Use: The 

primary function of the CMS–855 

Medicare enrollment application is to 

gather information from a provider or 

supplier that tells us who it is, whether 

it meets certain qualifications to be a 

health care provider or supplier, where 

it practices or renders its services, the 

identity of the owners of the enrolling 

entity, and other information necessary 

to establish correct claims payments. 

Form Number: CMS–855(A, B, I, R) 

(OCN: 0938–0685); Frequency: Yearly; 

Affected Public: Private Sector; Business 

or other for-profit and not-for-profit 

institutions; Number of Respondents: 

440,450; Total Annual Responses: 

440,450; Total Annual Hours: 856,395. 

(For policy questions regarding this 

contact Kim McPhillips at 410–786– 

5374. 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 

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 May 4, 2012. 

OMB, Office of Information and 

Regulatory Affairs, Attention: CMS 

Desk Officer, Fax Number: (202) 

395–6974, Email: 

OIRA_submission@omb.eop.gov. 

Dated: March 28, 2012. 

Martique Jones, 

Director, Regulations Development Group, 

Division B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2012–8010 Filed 4–3–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–855(S) and 

CMS–855(A,B,I,R); and CMS–10427] 

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: 

Medicare Enrollment Application— 

Durable Medical Equipment, 

Prosthetics, Orthotics and Supplies 

(DMEPOS) Suppliers Use: The primary 

function of the CMS 855S Durable 

Medical Equipment, Prosthetics, 

Orthotics and Supplies (DMEPOS) 

supplier enrollment application is to 

gather information from a supplier that 

tells us who it is, whether it meets 

certain qualifications to be a health care 

supplier, where it renders its services or 

supplies, the identity of the owners of 

the enrolling entity, and information 

necessary to establish the correct claims 

payment. The goal of evaluating and 

revising the CMS 855S DMEPOS 

supplier enrollment application is to 

simplify and clarify the information 

collection without jeopardizing our 

need to collect specific information. The 

majority of the revisions contained in 

this submission are non-substantive in 

nature such as spelling and formatting 

corrections; however, we also removed 

duplicate fields and obsolete questions 

and provided clarification and 

simplified the instructions for the 

completing the application. Form 

Number: CMS–855(S) (OCN: 0938– 

1056); Frequency: Yearly; Affected 

Public: Private Sector; Business or other 

for-profit and not-for-profit institutions; 

Number of Respondents: 43,350; Total 

Annual Responses: 43,350; Total 

Annual Hours: 113,550 (For policy 

questions regarding this contact Kim 

McPhillips at 410–786–5374. For all 

other issues call 410–786–1326.) 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Medicare 

Enrollment Application Use: The 

primary function of the CMS–855 

Medicare enrollment application is to 

gather information from a provider or 

supplier that tells us who it is, whether 

it meets certain qualifications to be a 

health care provider or supplier, where 

it practices or renders its services, the 

identity of the owners of the enrolling 

entity, and other information necessary 

to establish correct claims payments. 

Form Number: CMS–855(A, B, I, R) 

(OCN: 0938–0685); Frequency: Yearly; 

Affected Public: Private Sector; Business 

or other for-profit and not-for-profit 

institutions; Number of Respondents: 

440,450; Total Annual Responses: 

440,450; Total Annual Hours: 856,395 

(For policy questions regarding this 

contact Kim McPhillips at 410–786– 

5374. For all other issues call 410–786– 

1326.) 

3. Type of Information Collection 

Request: New collection; Title of 

Information Collection: For-Profit PACE 

Study; Use: The Program of All 

Inclusive Care of the Elderly (PACE) 

aims to provide integrated care and 

services to the frail elderly at risk of 

institutionalization to enable them to 

remain in the community. Under the 

Balanced Budget Act of 1997 (BBA), the 

not-for-profit PACE plans were 

established as permanent providers 

under the Medicare and Medicaid 

programs. The BBA also mandated a 

demonstration of for-profit PACE plans. 

This study will estimate the differences 

in quality and access to care between 

the for-profit and not-for-profit PACE 

plans. The data collected in the survey 

will be used to measure the outcomes of 

interest-differences in access to and 

quality of care delivered to PACE 

enrollees. To measure these key 

outcomes, the survey will collect data 

on access to and satisfaction with 

healthcare, personal care, and 

transportation assistance provided by 

the plans. Form Number: CMS–10427 

(OCN: 0938–New); Frequency: Yearly; 

Affected Public: Individuals. Number of 

Respondents: 813. Number of 

Responses: 813. Total Annual Hours: 

447. (For policy questions regarding this 

collection contact Julia Zucco at 410– 

786–6670. 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 

Paperwork@cms.hhs.gov, or call the 


emcdonald on DSK29S0YB1PROD with NOTICES