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[Federal Register Volume 89, Number 226 (Friday, November 22, 2024)]
[Notices]
[Pages 92689-92690]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-27359]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10902]

Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

AGENCY: Centers for Medicare & Medicaid Services, Health and Human 
Services (HHS).

ACTION: Notice.

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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 (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 a second opportunity 
for public comment on the notice. Interested persons are invited to 
send comments regarding the burden estimate or any other aspect of this 
collection of information, including the necessity and utility of the 
proposed information collection for the proper performance of the 
agency's functions, the accuracy of the estimated burden, ways to 
enhance the quality, utility, and clarity of the information to be 
collected, and the use of automated collection techniques or other 
forms of information technology to minimize the information collection 
burden.

DATES: Comments on the collection(s) of information must be received by 
the OMB desk officer by December 23, 2024.

ADDRESSES: Written comments and recommendations for the proposed 
information collection should be sent within 30 days of publication of 
this notice to www.reginfo.gov/public/do/PRAMain. Find this particular 
information collection by selecting ``Currently under 30-day Review--
Open for Public Comments'' or by using the search function.
    To obtain copies of a supporting statement and any related forms 
for the proposed collection(s) summarized in this notice, please access 
the CMS PRA website by copying and pasting the following web address 
into your web browser: https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.

FOR FURTHER INFORMATION CONTACT: William Parham at (410) 786-4669.

SUPPLEMENTARY INFORMATION: Under the Paperwork Reduction Act of 1995 
(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

[[Page 92690]]

3506(c)(2)(A) of the PRA (44 U.S.C. 3506(c)(2)(A)) requires Federal 
agencies to publish a 30-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 that summarizes the 
following proposed collection(s) of information for public comment:
    1. Type of Information Collection Request: New collection (Request 
for a new OMB control number); Title of Information Collection: 
Environmental Health Hazards Checklist Medicare Coverage for 
Individuals Exposed to Environmental Health Hazards; Use: Section 1881A 
of the Act provides an enrollment basis for individuals who have been 
exposed to environmental health hazards. Currently, the only 
individuals eligible for Medicare under this provision are those who 
were present in Lincoln County, Montana, and have an asbestos-related 
disease (ARD) diagnosis. Eligible individuals must be diagnosed with 
one or more asbestos-related conditions and have been present in 
Lincoln County, Montana, for a total of at least 6 months (need not be 
consecutive) in the period ending 10 years or more before diagnosis of 
an asbestos-related condition. This form provides verification from a 
provider so that SSA can determine eligibility for Medicare enrollment.
    SSA uses this information to determine whether an individual meets 
the requirements for Medicare enrollment on the basis of an 
Environmental Health Hazard. The form is faxed to the applicant's 
provider by SSA. The provider must complete and sign the form and 
submit it back to SSA via fax or mail. The information on the completed 
form is reviewed manually by SSA. Thus, the collection of this 
information does not involve the use of information technology. Form 
Number: CMS-10902 (OMB control number: 0938-New); Frequency: Once; 
Affected Public: Individuals and Households; Number of Respondents: 61; 
Total Annual Responses: 61; Total Annual Hours: 10. (For policy 
questions regarding this collection contact Tyrissa Woods at 410-786-
0286 or [email protected]).

William N. Parham III,
Director, Division of Information Collections and Regulatory Impacts, 
Office of Strategic Operations and Regulatory Affairs.
[FR Doc. 2024-27359 Filed 11-21-24; 8:45 am]
BILLING CODE 4120-01-P
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