97620 Federal Register / Vol. 89, No. 236 / Monday, December 9, 2024 / Notices 

The primary users of this information 

are State Medicaid (and where 

applicable CHIP) agencies and CMS. 

State agencies are expected to use the 

information collected for continuous 

quality improvement purposes. They 

will identify patterns of error in their 

eligibility processing operations and 

systems and take corrective actions to 

address issues and improve the 

eligibility determination process. CMS 

will use the data collected to identify 

and help those States that are most in 

need of technical assistance. CMS will 

also use the data set to identify potential 

weaknesses in Federal regulations. It 

will propose regulatory modifications 

designed to ensure that there are more 

effective quality controls in the 

eligibility determination process.; Form 

Number: CMS–319 (OMB control 

number: 0938–0147); Frequency: 

Occasionally; Affected Public: State, 

Local, or Tribal Governments; Number 

of Respondents: 35; Number of 

Responses: 647; Total Annual Hours: 

9,840. (For policy questions regarding 

this collection contact Camiel Rowe at 

410–786–0069.) 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Community 

Mental Health Center Cost Report Use: 

CMS requires the Form CMS–2088–17 

to determine a provider’s reasonable 

cost incurred in furnishing medical 

services to Medicare beneficiaries and 

reimbursement due to or from a 

provider. In addition, CMHCs may 

receive reimbursement through the cost 

report for Medicare reimbursable bad 

debts. CMS uses the Form CMS–2088– 

17 for rate setting; payment refinement 

activities, including market basket 

analysis; Medicare Trust Fund 

projections; and to support program 

operations. The primary function of the 

cost report is to determine provider 

reimbursement for services rendered to 

Medicare beneficiaries. Each CMHC 

submits the cost report to its contractor 

for reimbursement determination. 

Section 1874A of the Act describes the 

functions of the contractor. CMHCs 

must follow the principles of cost 

reimbursement, which require they 

maintain sufficient financial records 

and statistical data for proper 

determination of costs. The S series of 

worksheets collects the provider’s 

location, CBSA, date of certification, 

operations, and unduplicated census 

days. The A series of worksheets 

collects the provider’s trial balance of 

expenses for overhead costs, direct 

patient care services, and non-revenue 

generating cost centers. The B series of 

worksheets allocates the overhead costs 

to the direct patient care and nonrevenue generating cost centers using 

functional statistical bases. The 

Worksheet C computes the 

apportionment of costs between 

Medicare beneficiaries and other 

patients. The D series of worksheets are 

Medicare specific and calculate the 

reimbursement settlement for services 

rendered to Medicare beneficiaries. The 

Worksheet F collects the provider’s 

revenues and expenses data from the 

provider’s income statement. Form 

Number: CMS–2088–17 (OMB control 

number: 0938–0378); Frequency: 

Annually; Affected Public: Private 

Sector, Business or other for-profits, 

Not-for-profits institutions; Number of 

Respondents: 191; Total Annual 

Responses: 191; Total Annual Hours: 

17,190. (For policy questions regarding 

this collection contact Jill Keplinger at 

410–786–4550.) 

3. Type of Information Collection 

Request: Extension of a previously 

approved collection; Title of 

Information Collection: Federally 

Qualified Health Center Cost Report 

Form; Use: The Form CMS–224–14 cost 

report is needed to determine a 

provider’s reasonable cost incurred in 

furnishing medical services to Medicare 

beneficiaries and to calculate the FQHC 

settlement amount. These providers, 

paid under the FQHC prospective 

payment system (PPS), may receive 

reimbursement outside of the PPS for 

Medicare reimbursable bad debts, 

pneumococcal, influenza, and COVID– 

19 vaccines, and monoclonal antibody 

products. CMS uses the Form CMS– 

224–14 for rate setting; payment 

refinement activities, including 

developing a FQHC market basket; 

Medicare Trust Fund projections; and to 

support program operations. 

Additionally, the Medicare Payment 

Advisory Commission (MedPAC) uses 

the FQHC Medicare cost report data to 

calculate Medicare margins; to 

formulate recommendations to Congress 

regarding the FQHC PPS; and to 

conduct additional analysis of the 

FQHC PPS. Form Number: CMS–224–14 

(OMB control number: 0938–1298); 

Frequency: Yearly; Affected Public: 

Private Sector, State, Local, or Tribal 

Governments, Federal Government, 

Business or other for-profits, Not-forProfit Institutions; Number of 

Respondents: 2,967; Total Annual 

Responses: 2,967; Total Annual Hours: 

172,086. (For policy questions regarding 

this collection contact LuAnn Piccione 

at 410–786–5423.) 

4. Type of Information Collection 

Request: Extension of a currently 

approved information collection; Title 

of Information Collection: Medicare 

Request for Employment Information; 

Use: Section 1837(i) of the Social 

Security Act (the Act) provides for a 

SEP for individuals who delay enrolling 

in Medicare Part B because they are 

covered by a group health plan based on 

their own or a spouse’s current 

employment status. Disabled 

individuals with Medicare may also 

delay enrollment because they have 

large group health plan coverage based 

on their own or a family member’s 

current employment status. When these 

individuals apply for Medicare Part B, 

they must provide proof that the group 

health plan coverage is (or was) based 

on current employment status. Form 

CMS L564 provides this proof so that 

SSA can determine eligibility for the 

SEP. Individuals eligible for the SEP can 

enroll in Part B without incurring a late 

enrollment penalty (LEP). Individuals 

may also use this form to prove that 

their group health plan coverage is 

based on current employment status and 

to have the assessed Medicare LEP 

reduced. Form Number: CMS–R–297/ 

CMS–L564 (OMB control number: 

0938–0787); Frequency: Annually; 

Affected Public: Individuals or 

households, Business or other for-profits 

and Not-for-profit institutions; Number 

of Respondents: 594,998; Total Annual 

Responses: 594,998; Total Annual 

Hours: 243,949. (For policy questions 

regarding this collection contact 

Candace Carter at 410–786–8466 or 

Candace.Carter@cms.hhs.gov). 

William N. Parham, III, 

Director, Division of Information Collections 

and Regulatory Impacts, Office of Strategic 

Operations and Regulatory Affairs. 

[FR Doc. 2024–28857 Filed 12–6–24; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Submission for Office of Management 

and Budget for Review and Approval; 

‘‘State SNAP Agency NDNH Matching 

Program Performance Report’’ (Office 

of Management Budget #: 0970–0464) 

AGENCY: Office of Child Support 

Services, Administration for Children 

and Families, U.S. Department of Health 

and Human Services. 

ACTION: Request for public comments. 

SUMMARY: OCSS is requesting the Office 

of Management and Budget (OMB) to 

approve the ‘‘State SNAP Agency NDNH 

Matching Program Performance Report,’’ 


ddrumheller on DSK120RN23PROD with NOTICES1
Federal Register / Vol. 89, No. 236 / Monday, December 9, 2024 / Notices 97621 

with minor revisions, for an additional 

three years. State agencies administering 

their Supplemental Nutrition Assistance 

Program (SNAP) provide the annual 

performance report to OCSS in 

accordance with the computer matching 

agreement between state SNAP agencies 

and OCSS. The current OMB approval 

expires on February 28, 2025. 

DATES: Comments due January 8, 2025. 

The Office of Management and Budget 

(OMB) must make a decision about the 

collection of information between 30 

and 60 days after publication of this 

document in the Federal Register. 

Therefore, a comment is best assured of 

having its full effect if OMB receives it 

within 30 days of publication. 

ADDRESSES: Written comments and 

recommendations for the proposed 

information collection should be sent 

within 30 days of publication of this 

notice to www.reginfo.gov/public/do/ 

PRAMain. Find this particular 

information collection by selecting 

‘‘Currently under 30-day Review—Open 

for Public Comments’’ or by using the 

search function. You can also obtain 

copies of the proposed collection of 

information by emailing infocollection@

acf.hhs.gov. Identify all emailed 

requests by the title of the information 

collection. 

SUPPLEMENTARY INFORMATION: 

Description: State agencies 

administering SNAP are mandated to 

participate in a computer matching 

program with OCSS. The matching 

program compares SNAP applicant and 

recipient information with employment 

and wage information maintained in the 

National Directory of New Hires 

(NDNH). The outcomes of the compared 

information help State SNAP agencies 

verify an individual’s identity and 

determine a benefit eligibility. To 

receive NDNH information, state 

agencies enter into a computer matching 

agreement and adhere to its terms and 

conditions, including providing OCSS 

with annual performance outcomes 

attributable to the use of NDNH 

information. To fulfill OMB 

requirements, OCSS periodically reports 

performance measurements 

demonstrating how the use of 

information in the NDNH supports the 

OCSS strategic mission, goals, and 

objectives. These periodic reports 

include information derived from state 

SNAP agency annual NDNH 

performance reports. OCSS provides 

states with required performance report 

template and instructions, which OCSS 

revised to update the submission 

contacts and formatting, improve 

grammar, and to change ‘‘Office of Child 

Support Enforcement (OCSE)’’ to 

‘‘Office of Child Support Services 

(OCSS).’’ 

Respondents: State SNAP Agencies. 

ANNUAL BURDEN ESTIMATES

Information collection instrument Total number 

of respondents 

Annual number 

of responses 

per respondent 

Average burden 

hours per 

response 

Total annual 

burden hours 

SNAP Agency Performance Reporting Tool and Instructions ................. 53 1 0.83 43.99 

Authority: 42 U.S.C. 653(j)(10); 5 

U.S.C. 552a; and Pub. L. 111–352. 

Mary C. Jones, 

ACF/OPRE Certifying Officer. 

[FR Doc. 2024–28760 Filed 12–6–24; 8:45 am] 

BILLING CODE 4184–41–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Proposed Information Collection 

Activity; Electronic Document 

Exchange (Office of Management and 

Budget #: 0970–0435) 

AGENCY: Office of Child Support 

Services, Administration for Children 

and Families, U.S. Department of Health 

and Human Services. 

ACTION: Request for public comments. 

SUMMARY: The Office of Child Support 

Services (OCSS), Administration for 

Children and Families (ACF), is 

requesting the Office of Management 

and Budget (OMB) to approve the 

Electronic Document Exchange (EDE), 

with minor revisions, for an additional 

three years. State child support agencies 

(CSAs) use the EDE to improve case 

processing. The current OMB approval 

expires on June 30, 2025. 

DATES: Comments due February 7, 2025. 

In compliance with the requirements of 

the Paperwork Reduction Act of 1995, 

ACF is soliciting public comment on the 

specific aspects of the information 

collection described above. 

ADDRESSES: You can obtain copies of the 

proposed collection of information and 

submit comments by emailing 

infocollection@acf.hhs.gov. Identify all 

requests by the title of the information 

collection. 

SUPPLEMENTARY INFORMATION: 

Description: The EDE provides a 

centralized, secure system for 

authorized users in state CSAs to 

electronically exchange child support 

and spousal support case information 

with other state CSAs. EDE benefits 

state CSAs by reducing delays, costs, 

and barriers associated with interstate 

case processing. It increases state 

collections, improves document 

security, standardizes data sharing, 

increases state participation, and 

improves case processing, resulting in 

better overall child and spousal support 

outcomes. OCSS made minor updates to 

the Portal screens to enhance 

functionality and changed ‘‘Office of 

Child Support Enforcement (OCSE)’’ to 

‘‘Office of Child Support Services 

(OCSS).’’ 

Respondents: State CSAs 

ANNUAL BURDEN ESTIMATES

Instrument 

Annual 

number of 

respondents 

Annual 

number of 

responses 

per respondent 

Average 

burden hours 

per response 

Annual burden 

hours 

EDE Screens ........................................................................................... 49 7,383 0.017 6,150 


ddrumheller on DSK120RN23PROD with NOTICES1

I I