Document Headings

                    Document headings vary by document type but may contain                    the following:                  
                -                       the agency or agencies that issued and signed a document                    
                -                       the number of the CFR title and the number of each part                      the document amends, proposes to amend, or is directly                      related to                    
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###### Department of Health and Human Services

###### Centers for Medicare & Medicaid Services 

          - [Document Identifier: CMS-10161, CMS-1882, CMS-437A and B, CMS-1557 and CMS-10036] 

# AGENCY:

Centers for Medicare & Medicaid Services. 

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:*                     Extension of a currently approved collection;                     *Title of Information Collection:*                     New Freedom Initiative—Web-based Reporting System for Grantees;                     *Use:*                     CMS currently awards competitive grants to States and other eligible entities for the purpose of designing and implementing effective and enduring improvements in community-based long-term services                           ( print page 2079)                        and support systems. CMS currently requires grantees to report on a quarterly, semi-annual, and or annual basis depending upon the grant type. CMS requires the information obtained through web-based grantee reporting for two reasons: (1) In order to effectively monitor the grants; and, (2) To report to Congress and other interested stakeholders the progress and obstacles experienced by the grantees. The grantees are the respondents to the web-based reporting system.                     *Form Number:*                     CMS-10161 (OMB# 0938-0979);                     *Frequency:*                     annually, semi-annually, and quarterly;                     *Affected Public:*                     State, Local or Tribal Governments;                     *Number of Respondents:*                     171;                     *Total Annual Responses:*                     428;                     *Total Annual Hours:*                     3,764.                 

                    2.                     *Type of Information Collection Request:*                     Extension of a currently approved collection;                     *Title of Information Collection:*                     Request for Certification as a Supplier of Portable X-ray Services and Portable X-ray Survey Report Form under the Medicare/Medicaid Program and Supporting Regulations in 42 CFR 486.100-486.110;                     *Use:*                     The Medicare program requires portable X-ray suppliers to be surveyed for health and safety standards. The CMS-1882 is the survey form that records survey results. The CMS-1880 is used by the surveyor to determine if a portable X-ray applicant meets the eligibility requirements.                     *Form Numbers:*                     CMS-1880/1882 (OMB# 0938-0027);                     *Frequency:*                     Occasionally;                     *Affected Public:*                     State, Local or Tribal Governments;                     *Number of Respondents:*                     544;                     *Total Annual Responses:*                     68;                     *Total Annual Hours:*                     4,760.                 

                    3.                     *Type of Information Collection Request:*                     Extension of a currently approved collection;                     *Title of Information Collection:*                     Rehabilitation Hospital Criteria Worksheet and Rehabilitation Hospital Criteria Worksheet;                     *Use:*                     The rehabilitation hospital and rehabilitation unit criteria worksheets are necessary to verify that these facilities/units comply and remain in compliance with the exclusion criteria for the Medicare prospective payment system.                     *Form Number:*                     CMS-437A and 437B (OMB# 0938-0986);                     *Frequency:*                     Annually;                     *Affected Public:*                     Business or other for-profit;                     *Number of Respondents:*                     1,227;                     *Total Annual Responses:*                     1,227;                     *Total Annual Hours:*                     307.                 

                    4.                     *Type of Information Collection Request:*                     Extension of a currently approved collection;                     *Title of Information Collection:*                     Survey Report Form for Clinical Laboratory Improvement Amendments (CLIA) and Supporting Regulations in 42 CFR 493.1-493.2001;                     *Use:*                     This form is used by the State to determine a laboratory's compliance with CLIA. This information is needed for a laboratory's CLIA certification and recertification.                     *Form Number:*                     CMS-1557 (OMB# 0938-0544);                     *Frequency:*                     Biennially;                     *Affected Public:*                     Business or other for-profit, Not-for-profit institutions, State, Local or Tribal Governments and Federal Government;                     *Number of Respondents:*                     21,000;                     *Total Annual Responses:*                     10,500;                     *Total Annual Hours:*                     5,248.                 

                    5.                     *Type of Information Collection Request:*                     Extension of a currently approved collection;                     *Title of Information Collection:*                     Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) data and Supporting Regulations in 42 CFR 412 Subpart P;                     *Use:*                     This instrument with its supporting manual is needed to permit the Secretary of Health and Human Services, and CMS, to implement Section 1886(j) of the Social Security Act. The statute requires the Secretary to develop a prospective payment system for inpatient rehabilitation facility services for the Medicare program. This payment system is to cover both operating and capital costs for inpatient rehabilitation facility services. It applies to inpatient rehabilitation hospitals as well as rehabilitation units of acute care hospitals. CMS implemented the inpatient rehabilitation facility prospective payment system for cost reporting periods beginning on or after January 1, 2002.                

*Form Number:*                     CMS-10036 (OMB# 0938-0842);                     *Frequency:*                     Annually;                     *Affected Public:*                     Business or other for-profit, Not-for-profit institutions, State, Local or Tribal Governments and Federal Government;                     *Number of Respondents:*                     1,202;                     *Total Annual Responses:*                     396,660;                     *Total Annual Hours:*                     337,161.                 

                    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                     *February 13, 2009:*                     OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk Officer, New Executive Office Building, Room 10235, Washington, DC 20503, Fax Number: (202) 395-6974.                 

Dated: January 8, 2009. 

Michelle Shortt, 

Director, Regulations Development Group, Office of Strategic Operations and Regulatory Affairs. 

[FR Doc. E9-687 Filed 1-13-09; 8:45 am] 

BILLING CODE 4120-01-P