[Federal Register Volume 66, Number 198 (Friday, October 12, 2001)]
[Notices]
[Page 52138]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-25685]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-R-211]


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 and Medicaid Services 
(CMS) (formerly known as the Health Care Financing Administration 
(HCFA)), 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 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.
    Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Model Application 
Template for State Child Health Plan Under Title XXI of the Social 
Security Act, State Children's Health Insurance Program, and Model 
Application Template and Instructions; Form No.: CMS--(OMB# 0938-0707); 
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. The model application 
Template is used to assist States in submitting a State Child Health 
Plan and amendments to that plan; Frequency: Once; Affected Public: 
State, local, or tribal gov't; Number of Respondents: 42; Total Annual 
Responses: 42; Total Annual Hours: 3,360.
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access CMS's 
Web site address at http://www.hcfa.gov/regs/prdact95.htm, or E-mail 
your request, including your address, phone number, OMB number, and 
HCFA document identifier, to [email protected], 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 directly to the CMS Paperwork Clearance 
Officer designated at the following address: CMS, Office of Information 
Services, Security and Standards Group, Division of CMS Enterprise 
Standards, Attention: Julie Brown, CMS R 211, Room N2-14-26, 7500 
Security Boulevard, Baltimore, Maryland 21244-1850.

    Dated: October 4, 2001.
John P. Burke III,
Reports Clearance Officer, Security and Standards Group, Division of 
CMS Enterprise Standards.
[FR Doc. 01-25685 Filed 10-11-01; 8:45 am]
BILLING CODE 4120-03-P