[Federal Register Volume 67, Number 52 (Monday, March 18, 2002)]
[Notices]
[Pages 12019-12020]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-6348]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Center for Medicare and Medicaid Services

[CMS-R-211]


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

AGENCY: Center for Medicare and Medicaid Services, HHS.
    In compliance with the requirement of section 3506(c)(2)(A) of the 
Paperwork Reduction Act of 1995, the Center 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-R-211 (OMB# 0938-0707).
    Use: States are required to submit Title XXI plans and amendments 
for approval by the Secretary pursuant to

[[Page 12020]]

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' 
Web Site address at http://www.hcfa.gov/regs/prdact95.htm, or e-mail 
your request, including your address, phone number, OMB number, and CMS 
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 30 days of this notice directly to the OMB desk officer: OMB 
Human Resources and Housing Branch, Attention: Brenda Aguilar, New 
Executive Office Building, Room 10235, Washington, DC 20503.

    Dated: February 21, 2002.
John P. Burke III,
CMS Reports Clearance Officer, CMS Office of Information Services, 
Security and Standards Group, Division of CMS Enterprise Standards.
[FR Doc. 02-6348 Filed 3-15-02; 8:45 am]
BILLING CODE 4120-03-P