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[Federal Register Volume 75, Number 227 (Friday, November 26, 2010)]
[Notices]
[Page 72826]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-29718]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-116 and CMS-417]

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: Clinical 
Laboratory Improvement Amendments (CLIA) Application Form and 
Supporting Regulations in 42 CFR 493.1-.2001Medicare/Medicaid 
Psychiatric Hospital Survey Data; Use: The application must be 
completed by entities performing laboratory's testing specimens for 
diagnostic or treatment purposes. This information is vital to the 
certification process. Form Number: CMS-116 (OMB: 0938-0581); 
Frequency: Biennially and Occasionally; Affected Public: Private 
Sector: Business or other for-profits and Not-for-profit institutions; 
Number of Respondents: 219,000; Total Annual Responses: 31,520; Total 
Annual Hours: 23,640. (For policy questions regarding this collection 
contact Sheila Ward at 410-786-3115. For all other issues call 410-786-
1326.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Hospice Request 
for Certification in the Medicare Program; Use: The Hospice Request for 
Certification Form is the identification and screening form used to 
initiate the certification process and to determine if the provider has 
sufficient personnel to participate in the Medicare program. Form 
Number: CMS-417 (OMB: 0938-0313); Frequency: Annually; 
Affected Public: Private Sector: Business or other for-profits; Number 
of Respondents: 3,494; Total Annual Responses: 3,494; Total Annual 
Hours: 594. (For policy questions regarding this collection contact 
Debbie Terkay at 410-786-6835. 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 December 27, 
2010.

OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk 
Officer,
Fax Number: (202) 395-6974.
E-mail: OIRA_submission@omb.eop.gov.

    Dated: November 18, 2010.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 2010-29718 Filed 11-24-10; 8:45 am]
BILLING CODE 4120-01-P
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