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[Federal Register Volume 77, Number 124 (Wednesday, June 27, 2012)]
[Notices]
[Pages 38297-38298]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-15694]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier CMS-359 and -360]

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 
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: 
Comprehensive Outpatient Rehabilitation Facility (CORF) Eligibility and 
Survey Forms. Use: CMS-359 serves as the application for facilities 
wishing to participate in the Medicare/Medicaid program as CORFs. The 
form initiates the process for obtaining a decision as to whether the 
conditions of participation are met. It also promotes data reduction 
(key punching) or introduction to and retrieval from the Medicare/
Medicaid Automated Certification System, ASPEN, by the CMS Regional 
Offices (ROs). Should any question arise regarding the structure of the 
organization, this information is readily available without going 
through the process of completing the form again.
    CMS-360 is used by the State survey agency to record data collected 
to determine provider compliance with individual conditions of 
participation and to report it to the Federal government. CMS has the 
responsibility and authority for certification decisions which are 
based on provider compliance with the conditions of participation. The 
information needed to make these decisions is available to CMS only 
through use of information abstracted from the survey checklists. The 
form is primarily a worksheet designed to facilitate keypunching into 
the ASPEN by the State Agency after the survey is completed.
    Form Number: CMS-359 (CORF Eligibility Form) and CMS-360 (CORF 
Survey Report Form); OCN 0938-0267. Frequency: Occasionally. Affected 
Public: Private Sector (Business or other for-profits). Number of 
Respondents: 295. Total Annual Responses: 42. Total Annual Hours: 137. 
(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

[[Page 38298]]

be submitted in one of the following ways by August 27, 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: June 22, 2012.
Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2012-15694 Filed 6-26-12; 8:45 am]
BILLING CODE 4120-01-P
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