[Federal Register Volume 69, Number 214 (Friday, November 5, 2004)]
[Notices]
[Page 64575]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-24780]



[[Page 64575]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-10120]


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: New Collection; Title of 
Information Collection: 1932 State Plan Amendment Template, State Plan 
Requirements and Supporting Regulations in 42 CFR 438.50; Form No.: 
CMS-10120 (OMB0938-NEW); Use: The State Medicaid Agencies will 
complete the template. CMS will review the information to determine if 
the State has met all the requirements under 1932(1)(1)(A) and 42 CFR 
438.50. Once all requirements are met, the State will be allowed to 
enroll Medicaid beneficiaries on a mandatory basis into managed care 
entities without section 1115 or 1915(b) waiver authority.; Frequency: 
On occasion; Affected Public: State, local, or tribal government; 
Number of Respondents: 56; Total Annual Responses: 10; Total Annual 
Hours: 100.
    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/regulations/pra/, 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 at (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: Christopher Martin, New 
Executive Office Building, Room 10235, Washington, DC 20503.

    Dated: October 28, 2004.
John P. Burke, III,
Paperwork Reduction Act Team Leader, CMS Reports Clearance Officer, 
Office of Strategic Operations and Regulatory Affairs, Division of 
Regulations Development and Issuances.
[FR Doc. 04-24780 Filed 11-4-04; 8:45 am]
BILLING CODE 4120-03-M