[Federal Register Volume 75, Number 199 (Friday, October 15, 2010)]
[Notices]
[Page 63485]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-25932]



[[Page 63485]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-1561, CMS-R-308, CMS-10335 and CMS-R-53]


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

AGENCY: Centers for Medicare & Medicaid Services, HHS.
    In compliance with the requirement of section 3506I(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: Health Insurance 
Benefit Agreement; Use: Applicants to the Medicare program are required 
to agree to provide services in accordance with Federal requirements. 
The CMS-1561 is essential for CMS to ensure that applicants are in 
compliance with the requirements. Applicants will be required to sign 
the completed form and provide operational information to CMS to assure 
that they continue to meet the requirements after approval. Form 
Number: CMS-1561 (OMB<greek-i>: 0938-0832); Frequency: Yearly; Affected 
Public: Private Sector: Business or other for-profits and Not-for-
profit institutions; Number of Respondents: 3,000; Total Annual 
Responses: 3,000; Total Annual Hours: 500. (For policy questions 
regarding this collection contact JoAnn Perry at 410-786-3336. For all 
other issues call
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Children's Health 
Insurance Program; Use: States are required to submit title XXI plans 
and amendments for approval by the Secretary pursuant to section 2102 
of the Social Security Act in order to receive funds for initiating and 
expanding health insurance coverage for uninsured children. States are 
also required to submit State expenditure and statistical reports, 
annual reports and State evaluations to the Secretary as outlined in 
title XXI of the Social Security Act. Form Number: CMS-R-308 
(OMB<greek-i>: 0938-0841); Frequency: Yearly, Quarterly, Once and/or 
Occasionally; Affected Public: State, Local, or Tribal Governments; 
Number of Respondents: 56; Total Annual Responses: 1,114,124 Total 
Annual Hours: 864,973. (For policy questions regarding this collection 
contact Nancy Goetschius at 410-786-0707. For all other issues call 
410-786-1326.) 410-786-1326.)
    3. Type of Information Collection Request: New collection; Title of 
Information Collection: Current State Practices Related to Payments to 
Providers for Health Care- Acquired Conditions; Use: The Patient 
Protection and Affordable Care Act of 2010 (Affordable Care Act), 
enacted March 23, 2010 includes provisions prohibiting Federal 
Financial Participation to States for payments for health care-acquired 
conditions (HCACs). Section 2702(a) specifically requires that the 
Secretary identify current State practices that prohibit payment for 
HCACs and incorporate those practices or elements of those practices 
which she determines appropriate for application to the Medicaid 
program. In accordance with section 2702(a) of the Affordable Care Act, 
CMS is issuing this survey to States to obtain information on current 
State Medicaid practices for prohibiting payments for HCACs. Form 
Number: CMS-10335 (OMB<greek-i>: 0938-New); Frequency: Once; Affected 
Public: State, Local, or Tribal Governments; Number of Respondents: 50 
Total Annual Responses: 50; Total Annual Hours: 50 (For policy 
questions regarding this collection contact Venesa Day at 410-786-8281. 
For all other issues call 410-786-1326.)
    4. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Imposition of 
Cost Sharing Charges under Medicaid and Supporting Regulations in 42 
CFR 447.53; Use: The purpose of this collection is to ensure that 
States impose normal cost sharing charges upon categorically and 
medically needy individuals as allowed by law and implementing 
regulations. States must identify in their State plan the service for 
which the charge is made, the amount of the charge, the basis for 
determining the charge, the basis for determining whether an individual 
is unable to pay the charge and the way in which the individual will be 
identified to providers, and the procedures for implementing and 
enforcing the exclusions from cost sharing. Form Number: CMS-R-53 
(OMB<greek-i>: 0938-0429); Frequency: Occasionally; Affected Public: 
State, Local, or Tribal Governments; Number of Respondents: 56; Total 
Annual Responses: 2; Total Annual Hours: 20. (For policy questions 
regarding this collection contact Barbara Washington at 410-786-9964. 
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 <a href="/cdn-cgi/l/email-protection#481829382d3a3f273a23082b253b6620203b662f273e"><span class="__cf_email__" data-cfemail="b2e2d3c2d7c0c5ddc0d9f2d1dfc19cdadac19cd5ddc4">[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 November 15, 
2010.
    OMB, Office of Information and Regulatory Affairs, Attention: CMS 
Desk Officer, Fax Number: (202) 395-6974, E-mail: <a href="/cdn-cgi/l/email-protection#1f50564d5e406c6a7d72766c6c7670715f70727d317a706f31787069"><span class="__cf_email__" data-cfemail="db9492899a84a8aeb9b6b2a8a8b2b4b59bb4b6b9f5beb4abf5bcb4ad">[email protected]</span></a>.

    Dated: October 8, 2010.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 2010-25932 Filed 10-14-10; 8:45 am]
BILLING CODE 4120-01-P


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