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[Federal Register Volume 76, Number 247 (Friday, December 23, 2011)]
[Notices]
[Pages 80372-80373]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-33101]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-1880 and CMS-1882]

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

[[Page 80373]]

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 without change 
of a currently approved collection; Title of Information Collection: 
Certification as a Supplier of Portable X-Ray and Portable X-Ray Survey 
Report Form and Supporting Regulations at 42 CFR Part 486.100-486.110; 
Use: CMS-1880 is utilized as an application to be completed by 
suppliers of portable X-ray services requesting participation in the 
Medicare program. This form initiates the process of obtaining a 
decision as to whether the conditions of coverage are met as a portable 
X-ray supplier. It also promotes data reduction or introduction to, and 
retrieval from, the Certification and Survey Provider Enhanced 
Reporting (CASPER) by the CMS Regional Offices (ROs).
    CMS-1882 is used by the State survey agency to provide data 
collected during an on-site survey of a supplier of portable X-ray 
services to determine compliance with the applicable conditions of 
participation and to report this information to the Federal Government. 
The form is primarily a coding worksheet designed to facilitate data 
reduction and retrieval into the ASPEN system at the CMS ROs. The form 
includes basic information on compliance (i.e., met, not met, 
explanatory statements) and does not require any descriptive 
information regarding the survey activity itself. CMS has the 
responsibility and authority for certification decisions which are 
based on supplier compliance with the applicable conditions of 
participation. The information needed to make these decisions is 
available to CMS only through the use of information abstracted from 
the survey report form; Form Numbers: CMS-1880 (Request for 
Certification as a Supplier of Portable X-ray Services), CMS-1882 
(Medicare/Medicaid Portable X-ray Survey Report), and OCN 0938-0027; 
Frequency: Occasionally; Affected Public: State, Local, or Tribal 
Governments; Number of Respondents: 579; Total Annual Responses: 86; 
Total Annual Hours: 151. (For policy questions regarding this 
collection contact Georgia Johnson at (410) 786-6859. 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.
    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 February 21, 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: December 16, 2011.
Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2011-33101 Filed 12-22-11; 8:45 am]
BILLING CODE 4120-01-P
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