[Federal Register Volume 68, Number 244 (Friday, December 19, 2003)]
[Notices]
[Pages 70800-70801]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-31357]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-437, 437A, 437B; CMS-255; CMS-R-199; CMS-
10086]


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

    Agency: Centers for Medicare and Medicaid Services.
    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.
    1. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Psychiatric Unit 
Criteria Worksheet, Rehabilitation Unit Criteria Worksheet, and 
Rehabilitation Hospital Criteria Worksheet, and Supporting Regulations 
at 42 CFR 488.26; Form No.: CMS-437, 437A, and 437B (OMB 0938-
0358); Use: The rehabilitation hospital/unit and psychiatric unit 
criteria worksheets are necessary to verify and reverify that these 
facilities/units comply and remain in compliance with the exclusion 
criteria for the Medicare prospective payment system; Frequency: 
Annually; Affected Public: Business or other-for-profit, not-for-profit 
institutions; Number of Respondents: 2,610; Total Annual Responses: 
2,610; Total Annual Hours: 653.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Municipal Health 
Services Cost Report Form and supporting Regulations 42 CFR 405.2470; 
Form No.: CMS-255 (OMB 0938-0155); Use: The Municipal Health 
Services Program Cost Report (CMS 255) is used by the participating 
clinics to report costs for health care services rendered to Medicare 
beneficiaries. It is also used to gather data to properly evaluate the 
demonstration; Frequency: Annually; Affected Public: Not-for-profit 
institutions; Number of Respondents: 14; Total Annual Responses: 14; 
Total Annual Hours: 476.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicaid Report 
on Payables and Receivables; Form No.: CMS-R-199 (OMB 0938-
0697); Use: The Chief Financial Officers Act of 1990 requires 
government agencies to produce auditable financial statements. This 
form will collect accounting data from the States on Payables and 
Receivables; Frequency: Annually; Affected Public: State, local or 
tribal government; Number of Respondents: 57; Total Annual Responses: 
57; Total Annual Hours: 342.
    4. Type of Information Request: Extension of a currently approved 
collection; Type of Information Collection: Medicaid Program: Real 
Choice Systems Change Grants for Community Living; CMS Form Number: 
CMS-10086 (OMB 0938-0901); Use: Executive Order 13217, 
``Community-Based Alternatives for Individuals with Disabilities'' 
called upon the Federal government to assist States and localities to 
swiftly implement the decision of the United States Supreme Court in 
Olmstead v. L.C., stating: ``The United States is committed to 
community-based alternatives for individuals with disabilities and 
recognizes that such services advance the best interests of the United 
States.'' State agencies and community groups will be applying for 
these grants; Frequency: On occasion; Affected Public: State, local, or 
tribal government; not-for-profit institutions; Number of Respondents: 
75; Total Annual Responses: 150; Total Annual Burden Hours: 1500.
    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://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.


[[Page 70801]]


    Dated: December 12, 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. 03-31357 Filed 12-18-03; 8:45 am]
BILLING CODE 4120-03-P