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[Federal Register Volume 76, Number 178 (Wednesday, September 14, 2011)]
[Notices]
[Page 56767]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-23429]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10334]

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: Application for 
Coverage in the Pre-Existing Condition Insurance Plan; Use: The 
Department of Health and Human Services (HHS) Centers for Medicare & 
Medicaid Services, Center for Consumer Information and Insurance 
Oversight is requesting clearance by the Office of Management and 
Budget for modifications to this previously approved collection 
package. These changes are being requested to (1) provide a mechanism 
for a PCIP enrollee who has moved from a state-administered PCIP to 
quickly and efficiently enroll into the federally-administered PCIP (2) 
provide a mechanism for a PCIP applicant to identify a third party 
entity will pay their premium to ensure appropriate premium billing (3) 
provide a mechanism whereby a licensed insurance agent or broker may 
identify their referral of an applicant (4) request employer 
information to expand ways to identify and prevent instances of insurer 
dumping and (5) make clarifications to existing application language. 
Form Number: CMS-10334 (OCN: 0938-1095) Frequency: Once; Affected 
Public: Individuals or households; Number of Respondents: 83,333; 
Number of Responses: 83,333; Total Annual Hours: 179,499. (For policy 
questions regarding this collection, contact Laura Dash at 410-786-
8623. 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 October 14, 2011
    OMB, Office of Information and Regulatory Affairs, Attention: CMS 
Desk Officer, Fax Number: (202) 395-6974, E-mail: OIRA_submission@omb.eop.gov.

    Dated: September 8, 2011.
Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2011-23429 Filed 9-13-11; 8:45 am]
BILLING CODE 4120-01-P
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