8842 Federal Register / Vol. 87, No. 32 / Wednesday, February 16, 2022 / Notices 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifiers: CMS–10779 and 

CMS–3427] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

Medicaid Services, Health and Human 

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 

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 must be received by 

April 18, 2022. 

ADDRESSES: When commenting, please 

reference the document identifier or 

OMB control number. 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: ll, 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’ website address at 

https://www.cms.gov/Regulations-andGuidance/Legislation/ 

PaperworkReductionActof1995/PRAListing. 

FOR FURTHER INFORMATION CONTACT: 

William N. Parham at (410) 786–4669. 

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–10779—Complaints Submission 

Process under the No Surprises Act 

CMS–3427—End Stage Renal Disease 

Application and Survey and 

Certification Report 

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 Collection 

1. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Complaints 

Submission Process under the No 

Surprises Act; Use: The No Surprises 

Act directs the Departments to establish 

a process to receive complaints 

regarding violations of the application 

of qualifying payment amount (QPA) 

requirements by group health plans and 

health insurance issuers offering group 

or individual health coverage. The No 

Surprises Act also directs HHS to 

establish a process to receive consumer 

complaints regarding violations by 

health care providers, facilities, and 

providers of air ambulance services 

regarding balance billing requirements 

and to respond to such complaints 

within 60 days. CMS will request 

information from non-federal 

governmental plans and issuers, health 

care providers, facilities, providers of air 

ambulance services, and individuals to 

review and process a complaint for 

potential violations of balance billing 

requirements. Form Number: CMS– 

10779 (OMB control number: 0938– 

1406); Frequency: Occasionally; 

Affected Public: Private Sector (Business 

or other for-profit and Not-for-profit 

institutions); Number of Respondents: 

39,000; Total Annual Responses: 

39,000; Total Annual Hours: 19,500. 

(For policy questions regarding this 

collection contact Patrick Edwards at 

301–492–4371.) 

2. Type of Information Collection 

Request: Reinstatement with change of a 

previously approved collection; Title of 

Information Collection: End Stage Renal 

Disease Application and Survey and 

Certification Report; Use: The Form 

CMS–3427 is required for each new 

ESRD facility seeking initial 

certification and for each existing 

facility seeking recertification, 

relocation, expansion/change of 

service(s), or change of ownership. The 

form is also used for information 

collection purposes related to a 

complaint survey of an ESRD facility. 

The Form CMS–3427 information is 

currently collected on paper as a 

manual option or may be completed in 

an online fillable format based on 

facility preference. This online form is 

a step in the direction towards 

electronic submission. Form Number: 

CMS–3427 (OMB control number: 

0938–0360); Frequency: Every three 

years; Affected Public: Private sector 

(Business or other for-profit and Not-for 

profit institutions); Number of 

Respondents: 7,883; Total Annual 

Responses: 2,601; Total Annual Hours: 

866. (For policy questions regarding this 

collection contact Jennifer Milby at 410– 

786–8828.) 

Dated: February 10, 2022. 

William N. Parham, III, 

Director, Paperwork Reduction Staff, Office 

of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 2022–03286 Filed 2–15–22; 8:45 am] 

BILLING CODE P 


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