[Federal Register Volume 74, Number 9 (Wednesday, January 14, 2009)]
[Notices]
[Pages 2078-2079]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-687]


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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 Information Collection Activities: Submission for OMB 
Review; Comment Request

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

[[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<greek-i> 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<greek-i> 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<greek-i> 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<greek-i> 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<greek-i> 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 <a href="/cdn-cgi/l/email-protection#431322332631342c312803202e306d2b2b306d242c35"><span class="__cf_email__" data-cfemail="87d7e6f7e2f5f0e8f5ecc7e4eaf4a9efeff4a9e0e8f1">[email protected]</span></a>, 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


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