Federal Register / Vol. 70, No. 174 / Friday, September 9, 2005 / Notices 53665 

Dated: August 31, 2005. 

Joan F. Karr, 

Acting Reports Clearance Officer, Centers for 

Disease Control and Prevention. 

[FR Doc. 05–17892 Filed 9–8–05; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–416 and CMS–

10156] 

Agency Information Collection 

Activities: Proposed Collection; 

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) 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 functions; 

(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: Annual Early 

and Periodic Screening, Diagnostic and 

Treatment Services (EPSDT) 

Participation Report; Form No.: CMS–

416 (OMB #0938–0354); Use: States are 

required to submit an annual report on 

the provision of EPSDT services to CMS 

pursuant to section 1902(1)(43)(D) of the 

Social Security Act. These reports 

provide CMS with data necessary to 

assess the effectiveness of State EPSDT 

programs, to determine a state’s results 

in achieving its participation goal, and 

to respond to inquiries; Frequency: 

Annually; Affected Public: State, local 

or tribal Government; Number of 

Respondents: 56; Total Annual 

Responses: 56; Total Annual Hours: 

1,568. 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Retiree Drug 

Subsidy (RDS) Application and 

Instructions; Use: Under the Medicare 

Prescription Drug, Improvement, and 

Modernization Act (MMA) of 2003 and 

implementing regulations at 42 CFR 

subpart R plan sponsors (employers, 

unions) who offer prescription drug 

coverage to their qualified covered 

retirees are eligible to receive a 28% taxfree subsidy for allowable drug costs. In 

order to qualify, plan sponsors must 

submit a complete application to CMS 

with a list of retirees for whom it 

intends to collect the subsidy; Form 

Number: CMS–10156 (OMB#: 0938–

0957); Frequency: Quarterly, Monthly, 

Annually; Affected Public: Business or 

other for-profit, Not-for-profit 

institutions, Federal, State, local and/or 

tribal Government; Number of 

Respondents: 50,000; Total Annual 

Responses: 50,000; Total Annual Hours: 

2,025,000. 

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/ 

regulations/pra/, 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. 

Written comments and 

recommendations for the proposed 

information collections must be mailed 

within 60 days of this notice to the 

address below: CMS, Office of Strategic 

Operations and Regulatory Affairs, 

Division of Regulations Development, 

Attention: Melissa Musotto, Room C4–

26–05, 7500 Security Boulevard, 

Baltimore, Maryland 21244–1850. 

Dated: August 25, 2005. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. 05–17734 Filed 9–8–05; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–R–262] 

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: Plan Benefit 

Package (PBP) and Formulary 

Submission for Medicare Advantage 

(MA) Plans and Prescription Drug Plans 

(PDPs); Form No.: CMS–R–262 (OMB # 

0938–0763); Use: Under the Medicare 

Modernization Act (MMA), Medicare 

Advantage (MA) and Prescription Drug 

Plan (PDP) organizations are required to 

submit plan benefit package information 

to CMS for approval. Organizations will 

provide this information through the 

submission of the formulary and the 

PBP software; Frequency: On occasion, 

annually and other (as required by new 

legislation); Affected Public: Business or 

other for-profit and Not-for-profit 

institutions; Number of Respondents: 

470; Total Annual Responses: 2,092; 

Total Annual Hours: 5,546. 

To obtain copies of the supporting 

statement and any related forms for 

these paperwork collections referenced 

above, access CMS Web site address at 

http://www.cms.hhs.gov/regulations/ 

pra/, 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. 

Written comments and 

recommendations for these information 

collections will be considered if they are 

mailed within 30 days of this notice 

directly to the OMB desk officer: OMB 

Human Resources and Housing Branch, 

Attention: Christopher Martin, New 

Executive Office Building, Room 10235, 

Washington, DC 20503.