[Federal Register Volume 70, Number 78 (Monday, April 25, 2005)]
[Notices]
[Pages 21199-21200]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-8163]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-1856 & 1893, CMS-R-273]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services.
    In compliance with the requirement of section 3506(c)(2)(A) of the 
Paperwork Reduction Act of 1995, the Centers for Medicare & Medicaid 
Services (CMS) 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: Request for 
Certification in the Medicare and/or Medicaid Program to Provide 
Outpatient Physical Therapy (OPT) and/or Speech Pathology Services, OPT 
Speech Pathology Survey Report and Supporting Regulations in 42 CFR 
485.701-485.729.; Form No.: CMS-1856, CMS-1893 (OMB  0938-
0065); Use: The Medicare Program requires OPT providers to meet certain 
health and safety requirements. The request for certification form is 
used by State agency surveyors to determine if minimum Medicare 
eligibility requirements are met. The survey report form records the 
result of the on-site survey; Frequency: On occasion and Other--every 6 
years; Affected Public: Business or other for-profit; Number of

[[Page 21200]]

Respondents: 2,968; Total Annual Responses: 495; Total Annual Hours: 
866.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Community Mental 
Health Center Site Visit Assessment Tool and Supporting Regulations in 
42 CFR 410.2; Form No.: CMS-R-273 (OMB  0938-0770); Use: This 
collection instrument aids CMS in its efforts to ensure that new and 
existing Community Mental Health Centers (CMHC) are compliant with 
Medicare provider requirements, and all applicable Federal and State 
requirements. The collection pertains to CMHC's provision of pre-
admission screening to State mental health facilities and to expanding 
the collection tool's use into other program areas as a means to screen 
applicants, enrollees, and existing providers/suppliers to ensure their 
legitimacy to participate in the Medicare Program; Frequency: 
Reporting-Other, upon initial application or re-enrollment into the 
Medicare program; Affected Public: Business or other for-profit, Not-
for-profit institutions, and State, local or tribal government; Number 
of Respondents: 4,731; Total Annual Responses: 4,731; Total Annual 
Hours: 20,372.
    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 60 days of this notice directly to 
the CMS Paperwork Reduction Act Reports Clearance Office designated at 
the address below: CMS, Office of Strategic Operations and Regulatory 
Affairs, Division of Regulations Development, Attention: Melissa 
Musotto, PRA Analyst, Room C4-26-05, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850.

    Dated: April 15, 2005.
Michelle Shortt,
Acting Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 05-8163 Filed 4-22-05; 8:45 am]
BILLING CODE 4120-01-P