```

[Federal Register Volume 78, Number 235 (Friday, December 6, 2013)]
[Notices]
[Pages 73545-73546]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-29144]

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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-18F5, CMS-10120, and CMS-10346]

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 February 4, 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-18F5 Application for Hospital Insurance and Supporting Regulations
CMS-10120 1932(a) State Plan Amendment Template, State Plan 
Requirements, and Supporting Regulations

[[Page 73546]]

CMS-10346 Appeals of Quality Bonus Payment Determinations

    Under the 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 Collections

    1. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Application for 
Hospital Insurance and Supporting Regulations; Use: Regulations at 42 
CFR 406.6 specifies the individuals who must file an application for 
Medicare Hospital Insurance (Part A) and those who need not file an 
application for Part A. Section 406.7 lists CMS-18F5 as the application 
form. The form elicits information that the Social Security 
Administration and CMS need to determine entitlement to Part A and 
Supplementary Medical Insurance (Part B); Form Number: CMS-18F5 (OCN: 
0938-0251); Frequency: Once; Affected Public: Individuals or 
households; Number of Respondents: 50,000; Total Annual Responses: 
50,000; Total Annual Hours: 12,500. (For policy questions regarding 
this collection contact Naomi Rappaport at 410-786-2175).
    2. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: 1932(a) State 
Plan Amendment Template, State Plan Requirements, and Supporting 
Regulations; Use: Section 1932(a)(1)(A) of the Social Security Act (the 
Act) grants states the authority to enroll Medicaid beneficiaries on a 
mandatory basis into managed care entities (managed care organization 
(MCOs) and primary care case managers (PCCMs)). Under this authority, a 
state can amend its Medicaid state plan to require certain categories 
of Medicaid beneficiaries to enroll in managed care entities without 
being out of compliance with provisions of section 1902 of the Act on 
statewideness (42 CFR 431.50), freedom of choice (42 CFR 431.51) or 
comparability (42 CFR 440.230). The template may be used by states to 
easily modify their state plans if they choose to implement the 
provisions of section 1932(a)(1)(A); Form Number: CMS-10120 (OCN: 0938-
0933); Frequency: Once and occasionally; Affected Public: State, Local, 
or Tribal Governments; Number of Respondents: 56; Total Annual 
Responses: 15; Total Annual Hours: 65. (For policy questions regarding 
this collection contact Camille Dobson at 410-786-7062).
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Appeals of 
Quality Bonus Payment Determinations; Use: The information collected 
from Medicare Advantage organizations is considered by the 
reconsideration official and potentially the hearing officer to review 
our determination of the organization's eligibility for a quality bonus 
payment. Form Number: CMS-10346 (OCN: 0938-1129; Frequency: Yearly; 
Affected Public: Private sector--Business or other for-profits; Number 
of Respondents: 350; Total Annual Responses: 25; Total Annual Hours: 
200. (For policy questions regarding this collection contact Sarah 
Gaillot at 410-786-4637).

    Dated: December 3, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2013-29144 Filed 12-5-13; 8:45 am]
BILLING CODE 4120-01-P
```