Federal Register / Vol. 74, No. 113 / Monday, June 15, 2009 / Notices 28249 

within 30 days of publication. Written 

comments and recommendations for the 

proposed information collection should 

be sent directly to the following: Office 

of Management and Budget, Paperwork 

Reduction Project, Fax: 202–395–7245, 

Attn: Desk Officer for the 

Administration for Children and 

Families. 

Dated: June 10, 2009. 

Janean Chambers, 

Reports Clearance Officer. 

[FR Doc. E9–13985 Filed 6–12–09; 8:45 am] 

BILLING CODE 4184–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–10266] 

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: New collection; Title of 

Information Collection: Conditions of 

Participation: Requirements for 

Approval and Reapproval of Transplant 

Centers to Perform Organ Transplants 

and Supporting Regulations in 42 CFR 

482.74, 482.94, 482.100, 482.102, 

488.61; Use: The Conditions of 

Participation and accompanying 

requirements specified in the 

regulations are used by our surveyors as 

a basis for determining whether a 

transplant center qualifies for approval 

or re-approval under Medicare. CMS 

and the healthcare industry believe that 

the availability to the facility of the type 

of records and general content of 

records is standard medical practice and 

is necessary in order to ensure the wellbeing and safety of patients and 

professional treatment accountability. 

Form Number: CMS–10266 (OMB# 

0938–New); Frequency: Yearly; Affected 

Public: Business or other for-profits and 

Not-for-profit institutions; Number of 

Respondents: 514; Total Annual 

Responses: 3,270; Total Annual Hours: 

9,334. 

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 July 15, 2009. 

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: June 5, 2009. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. E9–13947 Filed 6–12–09; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier: CMS–304/304a, CMS– 

10288, CMS–10289 and CMS–1450 (UB–04)] 

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 without change of a 

currently approved collection; Title of 

Information Collection: Reconciliation 

of State Invoice and Prior Quarter 

Adjustment Statement; Use: Section 

1927 of the Social Security Act requires 

drug manufacturers to enter into and 

have in effect a rebate agreement with 

CMS in order for States to receive 

funding for drugs dispensed to 

Medicaid recipients. Drug 

manufacturers must complete and 

submit to States the 304 form (the 

Reconciliation of State Invoice Form) to 

explain any rebate payment adjustments 

for the current quarter, and complete 

and submit the 304A form (the Prior 

Quarter Adjustment Statement Form) to 

States to explain rebate payment 

adjustments to any prior quarters. Both 

forms are used to reconcile drug rebate 

payments made by manufacturers with 

the State invoices of rebates due. Form 

Number: CMS–304/304a (OMB#: 0938– 

0676); Frequency: Reporting—Quarterly; 

Affected Public: Private Sector: Business 

or other for profits; Number of 

Respondents: 570; Total Annual 

Responses: 3820; Total Annual Hours: 

141,080. (For policy questions regarding 

this collection contact Cindy Bergin at 

410–786–1176. For all other issues call 

410–786–1326.) 

2. Type of Information Collection 

Request: New Collection; Title of 

Information Collection: State Plan PrePrint to Implement Required Dental 

Benefits Pursuant of Children’s Health 

Insurance Program Reauthorizing Act 

(CHIPRA) 2009; Use: Section 501 of 

CHIPRA 2009 amends XXI and requires 

that ‘‘child health assistance provide to 

a targeted low-income child shall 

include coverage of dental services 

necessary to prevent disease and 

promote oral health, restore oral 

structures to health and function, and 

treat emergency conditions.’’ States that 

provide coverage in a separate 

Children’s Health Insurance Program 

may choose between two methods of 

providing the dental services required 

in Section 501. The State may define the 


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28250 Federal Register / Vol. 74, No. 113 / Monday, June 15, 2009 / Notices 

services in the dental benefit package 

and demonstrate that it includes all the 

required services. Alternatively, the 

State may provide a dental benefit 

package that is equivalent to one of the 

three benchmark packages described in 

the statute. In order to implement one 

of these options and comply with the 

statute, States must amend their State 

Plan using the State Plan pre-print. 

Form Number: CMS–10288 (OMB #: 

0938—NEW); Frequency: Reporting 

One-time; Affected Public: State, Local, 

or Tribal Governments; Number of 

Respondents: 51; Total Annual 

Responses: 51; Total Annual Hours: 

1530. (For policy questions regarding 

this collection contact Nancy 

Goetschius at 410–786–0707. For all 

other issues call 410–786–1326.) 

3. Type of Information Collection 

Request: New Collection; Title of 

Information Collection: Optional Dentalonly Supplemental Coverage State Plan 

Amendment Template; Use: CHIPRA 

2009 provides States with an option to 

provide supplemental dental-only 

coverage to children who would be 

eligible to enroll in the State’s 

Children’s Health Insurance Program 

(CHIP), except that they already have 

health insurance coverage, either 

through a group health plan or employer 

sponsored insurance. If the health 

insurance plan the child is enrolled in 

does not provide dental benefits, the 

State may provide the child with the 

same State-defined dental package or 

benchmark benefit plan provided to 

children who are eligible for the entire 

CHIP benefit package. The child will 

only be entitled to the dental services 

provided to other CHIP children. 

In order to choose this option, State 

must comply with all other 

requirements of the statute regarding 

cost sharing, income eligibility level, 

absence of a waiting list for their entire 

CHIP program (not just for dental 

coverage), and not providing more 

favorable treatment to children eligible 

for the supplemental dental benefit 

under this option. In order to implement 

this option States must amend their 

State Plan using the Supplemental 

Dental Benefits State Plan Amendment 

Template. Form Number: CMS–10289 

(OMB#: 0938—NEW); Frequency: 

Reporting One-time; Affected Public: 

State, local, or Tribal Governments; 

Number of Respondents: 51; Total 

Annual Responses: 51; Total Annual 

Hours: 1020. (For policy questions 

regarding this collection contact Nancy 

Goetschius at 410–786–0707. For all 

other issues call 410–786–1326.) 

4. Type of Information Collection 

Request: Extension of a currently 

approved collection; Title of 

Information Collection: Medicare 

Uniform Institutional Provider Bill and 

Supporting Regulations in 42 CFR 

424.5; Use: Section 42 CFR 424.5(a)(5) 

requires providers of services to submit 

a claim for payment prior to any 

Medicare reimbursement. Charges billed 

are coded by revenue codes. The bill 

specifies diagnoses according to the 

International Classification of Diseases, 

Ninth Edition (ICD–9–CM) code. 

Inpatient procedures are identified by 

ICD–9–CM codes, and outpatient 

procedures are described using the CMS 

Common Procedure Coding System 

(HCPCS). These are standard systems of 

identification for all major health 

insurance claims payers. Submission of 

information on the CMS–1450 permits 

Medicare intermediaries to receive 

consistent data for proper payment. 

Form Numbers: CMS–1450 (UB–04) 

(OMB#: 0938–0997); Frequency: 

Reporting—On occasion; Affected 

Public: Not-for-profit institutions, 

Business or other for-profit; Number of 

Respondents: 53,111; Total Annual 

Responses: 181,909,654; Total Annual 

Hours: 1,567,455. (For policy questions 

regarding this collection contact Matt 

Klischer at 410–786–7488. 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 

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 August 14, 2009: 

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 (CMS–10078), Room 

C4–26–05, 7500 Security Boulevard, 

Baltimore, Maryland 21244–1850. 

Dated: June 5, 2009. 

Michelle Shortt, 

Director, Regulations Development Group, 

Office of Strategic Operations and Regulatory 

Affairs. 

[FR Doc. E9–13944 Filed 6–12–09; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Indian Health Service 

[Funding Opportunity Number: HHS–2009– 

IHS–UIHP–0003] 

Office of Urban Indian Health 

Programs 

Announcement Type: Competitive 

Targeted Solicitation. 

Catalog of Federal Domestic 

Assistance Number: 93.193. 

Application Deadline Date: July 15, 

2009. 

Review Date: July 30, 2009. 

Earliest Anticipated Start Date: 

August 3, 2009. 

I. Funding Opportunity Description 

The Indian Health Service (IHS), 

Office of Urban Indian Health Programs 

(OUIHP) announces a limited targeted 

solicitation for the 4-in-1 Title V grants 

responding to an Office of HIV/AIDS 

Policy (OHAP), Minority AIDS 

(Acquired Immunodeficiency 

Syndrome) Initiative (MAI). This 

program is authorized under the 

authority of the Snyder Act and 25 

U.S.C. 1652, 1653 of the Indian Health 

Care Improvement Act, Public Law 94– 

437, as amended. This program is 

described at 93.193 in the Catalog of 

Federal Domestic Assistance (CFDA). 

This competitive targeted solicitation 

seeks to expand OUIHP’s existing Title 

V grants to increase the number of 

American Indian/Alaska Natives (AI/ 

AN) with awareness of his/her HIV 

status. This will provide routine and/or 

rapid HIV screening, prevention, preand post-test counseling (when 

appropriate). Enhancement of urban 

Indian health program HIV/AIDS 

activities is necessary to reduce the 

incidence of HIV/AIDS in the urban 

Indian health communities by 

increasing access to HIV related 

services, reducing stigma, and making 

testing routine. 

These grants and supplements will be 

used to enhance HIV testing, including 

rapid testing and/or standard HIV 

antibody testing and to provide a more 

focused effort to address HIV/AIDS 

prevention by targeting some of the 

largest urban Indian populations in the 

United States. The grantees will attempt 


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