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[Federal Register Volume 76, Number 117 (Friday, June 17, 2011)]
[Notices]
[Pages 35444-35445]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-15057]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier CMS-1856 and CMS-1893]

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: Extension of a currently 
approved collection; Title of Information Collection: (CMS-1856) 
Request for Certification in the Medicare and/or Medicaid Program to 
Provide Outpatient Physical Therapy and/or Speech Pathology Services, 
and (CMS-1893) Outpatient Physical Therapy--Speech Pathology Survey 
Report; Use: CMS-1856 is used as an application to be completed by 
providers of outpatient physical therapy and/or speech-language 
pathology services requesting participation in the Medicare and 
Medicaid programs. This form initiates the process for obtaining a 
decision as to whether the conditions of participation are met as a 
provider of outpatient physical therapy and/or

[[Page 35445]]

speech-language pathology services. It is used by the State agencies to 
enter new provider into the Automated Survey Process Environment 
(ASPEN). CMS-1893 is used by the State survey agency to record data 
collected during an on-site survey of a provider of outpatient physical 
therapy and/or speech-language pathology services, to determine 
compliance with the applicable conditions of participation, and to 
report this information to the Federal government. The form is 
primarily a coding worksheet designed to facilitate data reduction and 
retrieval into the ASPEN system. The information needed to make 
certification decisions is available to CMS only through the use of 
information abstracted from the form; Form Numbers: CMS-1856 and CMS-
1893 (OMB: 0938-0065); Frequency: Annually, occasionally; 
Affected Public: Private Sector; Business or other for-profit and not-
for-profit institutions; Number of Respondents: 2,968; Total Annual 
Responses: 495; Total Annual Hours: 866. (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 
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 July 18, 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: June 14, 2011.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 2011-15057 Filed 6-16-11; 8:45 am]
BILLING CODE 4120-01-P
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