[Federal Register Volume 70, Number 47 (Friday, March 11, 2005)]
[Notices]
[Pages 12220-12221]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-4886]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-R-211, CMS-R-306, CMS-R-185, and CMS-R-238]


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

AGENCY: Centers for Medicare & Medicaid Services, HHS.
    In compliance with the requirement of section 3506(c)(2)(A) of the

[[Page 12221]]

Paperwork Reduction Act of 1995, the Centers for Medicare & Medicaid 
Services (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 function; (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: 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; 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; Form Number: CMS-R-211 (OMB: 0938-0707); Frequency: 
Quarterly and annually; Affected Public: State, local or tribal 
government; Number of Respondents: 40; Total Annual Responses: 40; 
Total Annual Hours: 3,200.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Restraint and 
Seclusion Standards for Psychiatric Residential Treatment Facilities; 
Use: Psychiatric residential treatment facilities are required to 
report deaths, serious injuries and attempted suicides to State 
Medicaid Agency and Protection and Advocacy Organization. They are also 
required to provide residents restraint and seclusion policy in 
writing, and to document resident record of all activities involving 
use of restraint and seclusion. Form Number: CMS-R-306 (OMB: 
0938-0833); Frequency: On occasion; Affected Public: Business or other 
for-profit and not-for-profit institutions; Number of Respondents: 500; 
Total Annual Responses: 1,199,000; Total Annual Hours: 713,250.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Granting and 
Withdrawal of Deeming Authority to Private Nonprofit Accreditation 
Organizations and of State Exemption Under State Laboratory Program and 
Supporting Regulations in 42 CFR 493.551-493.557; Use: The information 
required is necessary to determine whether a private accreditation 
organization's or State licensure program's standards and 
accreditation/licensure process is equal to or more stringent than 
those of CLIA; Form Number: CMS-R-185 (OMB: 0938-0686); 
Frequency: As needed; Affected Public: Not-for-profit institutions, 
business or other for-profit, and State, local or tribal government; 
Number of Respondents: 8; Total Annual Responses: 76; Total Annual 
Hours: 768.
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Inpatient 
Psychiatric Services for Individuals Under Age 21 and Supporting 
Regulations in 42 CFR 441.151 and 441.152; Use: Certification 
requirements in Section 441.152 require that the certification of need 
for inpatient psychiatric services include documented clinical evidence 
that serves as the basis for the certification of need for inpatient 
psychiatric care. Section 1905(h)(1)(B) requires physicians and other 
personnel qualified to make determinations, with respect to mental 
health conditions and the treatment thereof, certify the need for care 
which they have determined to be necessary on an inpatient basis; Form 
Number: CMS-R-238 (OMB: 0938-0754); Frequency: Recordkeeping; 
Affected Public: State, local or tribal government, not-for-profit 
institutions and business or other for-profit; Number of Respondents: 
80,000; Total Annual Responses: 80,000; Total Annual Hours: 1.
    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 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: Christopher Martin, New Executive Office Building, Room 
10235, Washington, DC 20503.

    Dated: March 4, 2005.
John P. Burke, III,
CMS Paperwork Reduction Act Reports Clearance Officer, Office of 
Strategic Operations and Regulatory Affairs, Regulations Development 
Group.
[FR Doc. 05-4886 Filed 3-10-05; 8:45 am]
BILLING CODE 4120-03-P