[Federal Register Volume 68, Number 149 (Monday, August 4, 2003)]
[Notices]
[Page 45826]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-19699]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-643, CMS-668B, CMS-10067]


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

AGENCY: Centers 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 Centers for Medicare and Medicaid 
Services (CMS) (formerly known as the Health Care Financing 
Administration (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 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 request; Title of Information Collection: Hospice Survey and 
Deficiencies Report Form and Supporting Regulations at 42 CFR part 
488.26 and 4442.30; Form No.: CMS-643 (OMB 0938-0379); Use: In 
order to participate in the Medicare program, a hospice must meet 
certain Federal health and safety conditions of participation. This 
form will be used by State surveyors to record data about a hospice's 
compliance with these conditions of participation in order to initiate 
the certification or recertification process; Frequency: On occasion; 
Affected Public: Not-for-profit institutions, Business or other for-
profit; Number of Respondents: 2,339; Total Annual Responses: 475; 
Total Annual Hours: 238.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Post Laboratory 
Survey Questionnaire--Laboratory, and Supporting Regulations in 42 CFR 
493.1771, 493.1773, and 493.1777; Form No.: CMS-668B (OMB 
0938-0653); Use: To provide an opportunity and a mechanism for CLIA 
laboratories surveyed by CMS or CMS' agent to express their 
satisfaction and concerns about the CLIA survey process; Frequency: 
Biennially; Affected Public: Business or other for-profit, Not-for-
profit institutions; Number of Respondents: 22,500; Total Annual 
Responses: 11,250; Total Annual Hours: 2,813.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Pharmacy Plus 
Template for Low Income Seniors under Medicaid; Form No.: CMS-10067 
(OMB 0938-0889); Use: The template for the Pharmacy Plus 
program for low income seniors under Medicaid will enable states to 
apply, via a standard format, to provide a drug benefit to elderly 
recipients; use of this format will expedite the process of obtaining 
CMS review and approval of an application; Frequency: Other: 3 years 
after initial submission for the 1915 (c) waiver; 5 years after initial 
submission for the 1115 demonstration; Affected Public: State 
Government; Number of Respondents: 51; Total Annual Responses: 25; 
Total Annual Hours: 115.
    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://cms.hhs.gov/regulations/pra/default.asp, 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: July 28, 2003.
Julie Brown,
Acting, Paperwork Reduction Act Team Leader, CMS Reports Clearance 
Officer, Office of Strategic Operations and Strategic Affairs, Division 
of Regulations Development and Issuances.
[FR Doc. 03-19699 Filed 8-1-03; 8:45 am]
BILLING CODE 4120-03-P