47954 Federal Register / Vol. 73, No. 159 / Friday, August 15, 2008 / Notices 

Business or other for-profits, and 

Individual and households; Number of 

Respondents: 6,400; Total Annual 

Responses: 6,400; Total Annual Hours: 

1,472. 

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 Email 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 September 15, 2008. OMB Human 

Resources and Housing Branch, 

Attention: OMB Desk Officer, New 

Executive Office Building, Room 10235, 

Washington, DC 20503, Fax Number: 

(202) 395–6974. 

Dated: August 7, 2008. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. E8–18957 Filed 8–14–08; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–4040 and 

4040SP, CMS–R–10, CMS–10130A and 

10130B, and CMS–R–257] 

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: Request for 

Enrollment in Supplementary Medical 

Insurance; Use: Section 1836 of the 

Social Security Act and 42 CFR 407.10 

provide the eligibility requirements for 

enrollment in Supplementary Medical 

Insurance (Part B) for individuals age 65 

and older who are not entitled to 

premium-free Hospital Insurance (Part 

A). The form CMS–4040 is used to 

establish entitlement to Part B by 

individuals ineligible for Part A under 

Title XVIII of the Social Security Act. 

Form Number: CMS–4040 and 4040SP 

(OMB# 0938–0245); Frequency: Once; 

Affected Public: Individuals and 

households; Number of Respondents: 

10,000; Total Annual Responses: 

10,000; Total Annual Hours: 2,500. 

2. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: BPD–718: 

Advance Directives (Medicare and 

Medicaid); Use: Steps have been taken 

at both the Federal and State level to 

afford greater opportunity for the 

individual to participate in decisions 

made concerning the medical treatment 

to be received by an adult patient in the 

event that the patient is unable to 

communicate to others a preference 

about medical treatment. The individual 

may make his preference known 

through the use of an advance directive, 

which is a written instruction prepared 

in advance, such as a living will or 

durable power of attorney. This 

information is documented in a 

prominent part of the individual’s 

medical record. Advance directives as 

described in the Patient SelfDetermination Act have increased the 

individual’s control over decisions 

concerning medical treatment. The 

advance directives requirement was 

enacted because Congress wanted 

individuals to know that they have a 

right to make health care decisions and 

to refuse treatment even when they are 

unable to communicate. Sections 4206 

of OBRA ’90 defined an advance 

directive as a written instruction 

recognized under State law relating to 

the provision of health care when an 

individual is incapacitated (those 

persons unable to communicate their 

wishes regarding medical treatment). 

All states have enacted legislation 

defining a patient’s right to make 

decisions regarding medical care, 

including the right to accept or refuse 

medical or surgical treatment and the 

right to formulate advance directives. 

Participating hospitals, skilled nursing 

facilities/nursing facilities, home health 

agencies, providers of home health care, 

hospices, religious nonmedical health 

care institutions, and prepaid or eligible 

organizations (including Health Care 

Prepayment Plans (HCPPs) and 

Medicare Advantage Organizations 

(MAOs) such as Coordinated Care Plans, 

Demonstration Projects, Chronic Care 

Demonstration Projects, Program of All 

Inclusive Care for the Elderly, Private 

Fee for Service, and Medical Savings 

Accounts must provide written 

information, at explicit time frames, to 

all adult individuals about: (a) The right 

to accept or refuse medical or surgical 

treatments; (b) the right to formulate an 

advance directive; (c) a description of 

applicable State law (provided by the 

State); and (d) the provider’s or 

organization’s policies and procedures 

for implementing an advance directive. 

Form Number: CMS–R–10 (OMB# 

0938–0610); Frequency: Yearly; Affected 

Public: Business or other for-profits; 

Number of Respondents: 35,484; Total 

Annual Responses: 19,870,000; Total 

Annual Hours: 927,550. 

3. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Federal 

Reimbursement of Emergency Health 

Services Furnished to Undocumented 

Aliens, Section 1011 of the Medicare 

Prescription Drug, Improvement and 

Modernization Act of 2003 (MMA): 

‘‘Section 1011 Provider Payment 

Determination’’ and ‘‘Request for 

Section 1011 Hospital On-Call Payments 

to Physicians’’ Forms; Use: Section 1011 

of the MMA requires that the Secretary 

establish a process under which eligible 

providers (certain hospitals, physicians 

and ambulance providers) may request 

payment for (claim) their otherwise unreimbursed costs of providing eligible 

services. The Secretary must make 

quarterly payments directly to such 

providers. The Secretary must also 

implement measures to ensure that 

inappropriate, excessive, or fraudulent 

payments are not made under Section 

1011, including certification by 

providers of the accuracy of their 

requests for payment. The Section 1011 

Provider Payment Determination and 

the Request for Section 1011 Hospital 

On-Call Payments to Physicians forms 

have been established to address the 

statutory requirements. Form Number: 

CMS–10130A and 10130B (OMB# 0938–

0952); Frequency: Daily, Weekly, 

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Federal Register / Vol. 73, No. 159 / Friday, August 15, 2008 / Notices 47955 

Monthly, Quarterly and Yearly; Affected 

Public: Business or Other For-Profits 

and Not-for-Profit Institutions; Number 

of Respondents: 12,037; Total Annual 

Responses: 300,148; Total Annual 

Hours: 75,007. 

4. Type of Information Collection 

Request: Revision of a currently 

approved collection; Title of 

Information Collection: Medicare 

Advantage & Part D Disenrollment 

Requests Collected Through 1–800–

MEDICARE; Use: Section 4001 of the 

Balanced Budget Act of 1997 amended 

the Social Security Act to add Section 

1851(c)(1), through which Medicare 

Advantage elections are made and 

changed. Section 101 of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act amended the Social 

Security Act to include section 1860D–

1(b)(1), through which Medicare 

Prescription Drug Plan enrollments are 

made and changed. The disenrollment 

process offered at 1–800–MEDICARE 

provides beneficiaries with the option of 

submitting a disenrollment request to a 

neutral third party, who then processes 

the disenrollment action as a change of 

enrollment. 

The collection updates: 1. Continue to 

allow Medicare beneficiaries to 

disenroll from Medicare Advantage 

plans by calling CMS’ toll-free call 

center; 2. Continue to allow Medicare 

beneficiaries enrolled in Medicare 

Prescription Drug (Part D) Plans to 

request disenrollment from Medicare 

Prescription Drug Plans, and 3. Retire 

the CMS–R–257 Medicare Advantage 

Disenrollment Form given limited (zero) 

requests for the paper form since 2005. 

The information collected in the 

disenrollment process will be used to 

update the Medicare beneficiary’s 

Health Insurance Master Record System 

in order to disenroll the beneficiary 

from a Medicare Advantage managed 

care plan or a Medicare prescription 

drug plan on a timely basis. Form 

Number: CMS–R–257 (OMB# 0938–

0741); Frequency: Occasionally; 

Affected Public: Individuals or 

households; Number of Respondents: 

117,000; Total Annual Responses: 

117,000; Total Annual Hours: 19,539. 

To obtain copies of the supporting 

statement and any related forms for the 

proposed paperwork collections 

referenced above, access CMS’ Web Site 

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

PaperworkReductionActof1995, or email 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. 

In commenting on the proposed 

information collections please reference 

the document identifier or OMB control 

number. To be assured consideration, 

comments and recommendations must 

be submitted in one of the following 

ways by October 14, 2008: 

1. Electronically. You may submit 

your comments electronically to http:// 

www.regulations.gov. Follow the 

instructions for ‘‘Comment or 

Submission’’ or ‘‘More Search Options’’

to find the information collection 

document(s) accepting comments. 

2. By regular mail. You may mail 

written comments to the following 

address: CMS, Office of Strategic 

Operations and Regulatory Affairs, 

Division of Regulations Development, 

Attention: Document Identifier/OMB 

Control Number, Room C4–26–05, 7500 

Security Boulevard, Baltimore, 

Maryland 21244–1850. 

Dated: August 7, 2008. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. E8–18958 Filed 8–14–08; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Submission for OMB Review; 

Comment Request 

Title: Evaluation of the Improving 

Child Welfare Outcome through 

Systems of Care Grant Program. 

OMB No.: 0970–0288. 

Description: The 1994 Amendments 

to the Social Security Act (SSA) 

authorize the U.S. Department of Health 

and Human Services to review State 

child and family service programs to 

ensure conformance with the 

requirements in titles IV–B and IV–E of 

SSA. Under the Final Rule, which took 

effect March 25, 2000, States are 

assessed for substantial conformity with 

certain Federal requirements for childwelfare services. The Child and Family 

Service Reviews (CFSR), administered 

by the Children’s Bureau, are designed 

to ensure conformity with Federal childwelfare requirements and, ultimately, to 

help States improve child welfare 

services and outcomes, specifically 

safety, permanency and well-being 

outcomes for child-welfare-involved 

children and their families. States 

determined not to have achieved 

substantial conformity in any of the 

areas assessed are required to develop 

and implement Program Improvement 

Plans (PIP) addressing the areas of 

nonconformity. 

The Systems of Care grant cluster, 

from which these data are proposed to 

be collected, is designed to encourage 

public child-welfare agencies to address 

the issues identified in their State’s 

CPSR. The data collected from these 

demonstration sites will allow the 

Children’s Bureau to test whether this 

approach can help States reach the goals 

stated in their PIP and explore how 

child-welfare can benefit from being 

part of a system of care. Data will be 

collected via interviews, forms 

completed by project staff, surveys, 

focus groups and case-file reviews. Data 

also will be collected to determine the 

extent to which the Technical 

Assistance (TA) provided, brokered or 

contracted by the TA and Evaluation 

Center is meeting the needs of the 

grantees, and how. 

Respondents: Systems of Care Project 

Directors (members of the Systems of 

Care collaborative may include 

representatives from mental health, 

juvenile justice, education, health, 

among others); child-welfare agency 

supervisors and caseworkers; partner 

agency caseworkers; and families who 

have been involved with the childwelfare system. 

ANNUAL BURDEN ESTIMATES

Instrument Affected public Number of 

respondents 

Number of 

responses per 

respondent 

Average 

burden hours 

per response 

Total burden 

hours 

Stakeholder Survey ........................... Individuals/Households .................... 20 1 .5 10 

Private Sector .................................. 60 1 .5 30 

State/Local/Tribal ............................. 190 1 .5 95 

Child-Welfare Agency Survey ........... State/Local/Tribal ............................. 600 1 1 600 

Supervisor Interviews ........................ State/Local/Tribal ............................. 90 1 1 90 

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