[Federal Register Volume 70, Number 150 (Friday, August 5, 2005)]
[Notices]
[Pages 45397-45401]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-15165]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services


Privacy Act of 1974; Report of a New System of Records

AGENCY: Department of Health and Human Services (HHS), Centers for 
Medicare & Medicaid Services (CMS).

ACTION: Notice of a New System of Records.

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SUMMARY: In accordance with the requirements of the Privacy Act of 
1974, we are proposing to establish a new system titled ``Federal 
Reimbursement of Emergency Health Services Furnished to Undocumented 
Aliens (Section 1011),'' System No. 09-07-0546. The system will contain 
enrollment and payment request information, in support of a short-term 
program which pays hospitals, certain physicians, and ambulance 
providers (including Indian Health Service (IHS) facilities whether 
operated by the IHS or by an Indian Tribe or tribal organization) for 
their otherwise un-reimbursed costs of services provided under the 
provisions of section 1867 (Emergency Medical Treatment and Labor Act) 
(EMTALA) of the Social Security Act (the Act) and related hospital 
inpatient and outpatient services and ambulance services furnished to 
undocumented aliens, aliens paroled into the United States (U.S.) at a 
U. S. port of entry for the purposes of receiving such services, and 
Mexican citizens permitted temporary entry to the U.S. for not more 
than 30 days under the authority of a biometric machine readable border 
crossing identification card (also referred to as a ``laser visa'') 
issued in accordance with the requirements of regulations prescribed 
under the Immigration and Nationality Act. This system is being 
established under provisions of Section 1011 of the Medicare 
Prescription Drug, Improvement and Modernization Act of 2003 
Modernization Act of 2003 (MMA).
    The primary purpose of the system is to maintain information 
collected on individuals who submit an enrollment application and make 
payment requests associated with Section 1011 of the MMA, and other 
information designed to support the enrollment, claims payment, and 
research reporting functions of the Section 1011 program. Information 
retrieved from this system will also be disclosed to: (1) Support 
regulatory, payment activities, and policy functions performed within 
the agency or by a designated contractor or consultant; (2) combat 
fraud and abuse in certain health benefits programs; (3) assist another 
Federal or state agency with information to enable such agency to 
administer a Federal health benefits program, or to enable such agency 
to fulfill a requirement of a Federal statute or regulation that 
implements a health benefits program funded in whole or in part with 
Federal; (4) funds support constituent requests made to a Congressional 
representative; and, (5) support litigation involving the agency. We 
have provided background information about the new system in the 
SUPPLEMENTARY INFORMATION section below. Although the Privacy Act 
requires only that the ``routine use'' portion of the system be 
published for comment, CMS invites comments on all portions of this 
notice. See DATES section for comment period.

DATES: CMS filed a new system report with the Chair of the House 
Committee on Government Reform and Oversight, the Chair of the Senate 
Committee on Governmental Affairs, and the Administrator, Office of 
Information and Regulatory Affairs, Office of Management and Budget 
(OMB) on July 21, 2005. In any event, we will not disclose any 
information under a routine use until 40 days after publication. We may 
defer implementation of this system or one or more of the routine use 
statements listed below if we receive comments that persuade us to 
defer implementation.

ADDRESSES: The public should address comments to: CMS Privacy Officer, 
Division of Privacy Compliance Data Development (DPCDD), CMS, Mail Stop 
N2-04-27, 7500 Security Boulevard, Baltimore, Maryland 21244-1850. 
Comments received will be available for review at this location, by 
appointment, during regular business hours, Monday through Friday from 
9 a.m.-3 p.m., eastern time zone.

FOR FURTHER INFORMATION CONTACT: Section 1011 Project Officer, Center 
for Medicare Management, CMS, Mailstop C4-10-07, 7500 Security 
Boulevard, Baltimore, Maryland 21244-1850.

SUPPLEMENTARY INFORMATION: Sections 1866(a)(1)(I), 1866(a)(1)(N), and 
1867 of the Act impose specific obligations on

[[Page 45398]]

Medicare-participating hospitals that offer emergency services. These 
obligations concern individuals who come to a hospital emergency 
department and request examination or treatment for medical conditions, 
and apply to all of these individuals, regardless of whether or not 
they are beneficiaries of any program under the Act. Section 1867 of 
the Act sets forth requirements for medical screening examinations of 
medical conditions, as well as necessary stabilizing treatment or 
appropriate transfer. In addition, section 1867(h) of the Act 
specifically prohibits a delay in providing required screening or 
stabilization services in order to inquire about the individual's 
payment method or insurance status. Section 1867(d) of the Act provides 
for the imposition of civil monetary penalties on hospitals responsible 
for negligently violating a requirement of that section, through 
actions such as the following: (a) Negligently failing to appropriately 
screen an individual seeking medical care; (b) negligently failing to 
provide stabilizing treatment to an individual with an emergency 
medical condition; or (c) negligently transferring an individual in an 
inappropriate manner. (Section 1867(e)(4) of the Act defines 
``transfer'' to include both transfers to other health care facilities 
and cases in which the individual is released from the care of the 
hospital without being moved to another health care facility.)
    These provisions, taken together, are frequently referred to as the 
Emergency Medical Treatment and Labor Act (EMTALA), also known as the 
patient antidumping statute. EMTALA was passed in 1986 as part of the 
Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). 
Congress enacted these antidumping provisions in the Act because of its 
concern with an increasing number of reports that hospital emergency 
rooms were refusing to accept or treat individuals with emergency 
conditions if the individuals did not have insurance.

I. Description of the New System of Records

A. Statutory and Regulatory Basis for System

    The authority to conduct the program is given under the provisions 
of Section 1011 of the Medicare Prescription Drug, Improvement and 
Modernization Act of 2003 (Pub. L. 108-173).

B. Collection and Maintenance of Data in the System

    The Section 1011 program includes the provider name and 
identification number, provider address, provider employer 
identification number, provider banking information, provider federal 
tax identification number, patient's control number, medical record 
number, date of service, patient's gender, zip code, state and county, 
the principle diagnosis code, admitting diagnosis code, and total 
charges. It also includes claims information related to Section 1011 
payment requests, and other research information needed to pay claims 
and administer the Section 1011 program.

II. Agency Policies, Procedures, and Restrictions on the Routine

    The Privacy Act permits us to disclose information without an 
individual's consent if the information is to be used for a purpose 
that is compatible with the purpose(s) for which the information was 
collected. Any such disclosure of data is known as a ``routine use.'' 
The government will only release Section 1011 program information that 
can be associated with an individual provider as provided for under 
``Section III. Entities Who May Receive Disclosures under Routine 
Use.'' Both identifiable and non-identifiable data may be disclosed 
under a routine use. Identifiable data includes individual records with 
Section 1011 program information and identifiers. Non-identifiable data 
includes individual records with Section 1011 program information and 
masked identifiers or Section 1011 program information with identifiers 
stripped out of the file.
    We will only disclose the minimum personal data necessary to 
achieve the purpose of the Section 1011 program. CMS has the following 
policies and procedures concerning disclosures of information that will 
be maintained in the system. In general, disclosure of information from 
the system will be approved only for the minimum information necessary 
to accomplish the purpose of the disclosure after CMS:
    1. Determines that the use or disclosure is consistent with the 
reason that the data is being collected; e.g., to maintain information 
needed when submitting an enrollment application and make payment 
requests associated with Section 1011(a) of the MMA;.
    2. Determines that:
    a. The purpose for which the disclosure is to be made can only be 
accomplished if
    b. The record is provided in individually identifiable form;
    c. The purpose for which the disclosure is to be made is of 
sufficient importance to warrant the effect and/or risk on the privacy 
of the individual that additional exposure of the record might bring; 
and
    d. There is a strong probability that the proposed use of the data 
would in fact accomplish the stated purpose(s).
    3. Requires the information recipient to:
    a. Establish administrative, technical, and physical safeguards to 
prevent unauthorized use of disclosure of the record;
    b. Remove or destroy at the earliest time all patient-identifiable 
information; and
    c. Agree to not use or disclose the information for any purpose 
other than the stated purpose under which the information was 
disclosed.
    4. Determines that the data are valid and reliable.

III. Proposed Routine Use Disclosures of Data in the System

A. Entities Who May Receive Disclosures Under Routine Use

    These routine uses specify circumstances, in addition to those 
provided by statute in the Privacy Act of 1974, under which CMS may 
release information from the Section 1011 program without the consent 
of the individual to whom such information pertains. Each proposed 
disclosure of information under these routine uses will be evaluated to 
ensure that the disclosure is legally permissible, including but not 
limited to ensuring that the purpose of the disclosure is compatible 
with the purpose for which the information was collected. We are 
proposing to establish the following routine use disclosures of 
information maintained in the system:
    1. To agency contractors or consultants who have been contracted by 
the agency to assist in the performance of a service related to this 
system and who need to have access to the records in order to perform 
the activity.
    We contemplate disclosing information under this routine use only 
in situations in which CMS may enter into a contractual or similar 
agreement with a third party to assist in accomplishing agency business 
functions relating to purposes for this system of records.
    CMS occasionally contracts out certain of its functions when doing 
so would contribute to effective and efficient operations. CMS must be 
able to give a contractor whatever information is necessary for the

[[Page 45399]]

contractor to fulfill its duties. In these situations, safeguards are 
provided in the contract prohibiting the contractor from using or 
disclosing the information for any purpose other than that described in 
the contract and requires the contractor to return or destroy all 
information at the completion of the contract.
    2. To a CMS contractor that assists in the administration of a CMS-
administered health benefits program, when disclosure is deemed 
reasonably necessary by CMS to prevent, deter, discover, detect, 
investigate, examine, prosecute, sue with respect to, defend against, 
correct, remedy, or otherwise combat fraud or abuse in such program.
    We contemplate disclosing information under this routine use only 
in situations in which CMS may enter into a contractual relationship or 
grant with a third party to assist in accomplishing CMS functions 
relating to the purpose of combating fraud and abuse.
    CMS occasionally contracts out certain of its functions and makes 
grants when doing so would contribute to effective and efficient 
operations. CMS must be able to give a contractor or grantee whatever 
information is necessary for the contractor or grantee to fulfill its 
duties. In these situations, safeguards are provided in the contract 
prohibiting the contractor or grantee from using or disclosing the 
information for any purpose other than that described in the contract 
and requiring the contractor or grantee to return or destroy all 
information.
    3. To another Federal agency or to an instrumentality of any 
governmental jurisdiction within or under the control of the United 
States (including any State or local governmental agency), that 
administers, or that has the authority to investigate potential fraud 
or abuse in, a health benefits program funded in whole or in part by 
Federal funds, when disclosure is deemed reasonably necessary by CMS to 
prevent, deter, discover, detect, investigate, examine, prosecute, sue 
with respect to, defend against, correct, remedy, or otherwise combat 
fraud or abuse in such programs.
    Other agencies may require Section 1011 program information for the 
purpose of combating fraud and abuse in such Federally-funded programs. 
Releases of information would be allowed if the proposed use(s) for the 
information proved compatible with the purposes of collecting the 
information.
    4. To another Federal or state agency to:
    a. Contribute to the accuracy of CMS'' proper payment of a health 
benefit, or
    b. Enable such agency to administer a Federal health benefits 
program, or as necessary to enable such agency to fulfill a requirement 
of a Federal statute or regulation that implements a health benefits 
program funded in whole or in part with Federal funds.
    Other Federal or state agencies in their administration of a 
Federal health program may require Section 1011 program information in 
order to ensure that proper payment for services were provided. 
Releases of information would be allowed if the proposed use(s) for the 
information proved compatible with the purpose for which CMS collects 
the information.
    5. To a Member of Congress or to a congressional staff member in 
response to an inquiry of the Congressional Office made at the written 
request of the constituent about whom the record is maintained.
    Individuals sometimes request the help of a Member of Congress in 
resolving some issue relating to a matter before CMS. The Member of 
Congress then writes CMS, and CMS must be able to give sufficient 
information to be responsive to the inquiry.
    6. To the Department of Justice (DOJ), court or adjudicatory body 
when:
    a. The agency or any component thereof, or
    b. Any employee of the agency in his or her official capacity; or
    c. Any employee of the agency in his or her individual capacity 
where the DOJ has agreed to represent the employee, or
    d. The United States Government;
    Is a party to litigation or has an interest in such litigation, and 
by careful review, CMS determines that the records are both relevant 
and necessary to the litigation.
    Whenever CMS is involved in litigation, or occasionally when 
another party is involved in litigation and CMS' policies or operations 
could be affected by the outcome of the litigation, CMS would be able 
to disclose information to the DOJ, court or adjudicatory body 
involved. A determination would be made in each instance that, under 
the circumstances involved, the purposes served by the use of the 
information in the particular litigation is compatible with a purpose 
for which CMS collects the information.

B. Additional Provisions Affecting Routine Use Disclosures

    This system contains Protected Health Information (PHI) as defined 
by HHS regulation ``Standards for Privacy of Individually Identifiable 
Health Information'' (45 CFR parts 160 and 164, 65 FR 82462 (12-28-00), 
Subparts A and E. Disclosures of PHI authorized by these routine uses 
may only be made if, and as, permitted or required by the ``Standards 
for Privacy of Individually Identifiable Health Information.''
    In addition, our policy will be to prohibit release even of not 
directly identifiable, except pursuant to one of the routine uses or if 
required by law, if we determine there is a possibility that an 
individual can be identified through implicit deduction based on small 
cell sizes (instances where the patient population is so small that 
individuals who are familiar with the enrollees could, because of the 
small size, use this information to deduce the identity of the 
beneficiary).

IV. Safeguards

    CMS has safeguards in place for authorized users and monitors such 
users to ensure against excessive or unauthorized use. Personnel having 
access to the system have been trained in the Privacy Act and 
information security requirements. Employees who maintain records in 
this system are instructed not to release data until the intended 
recipient agrees to implement appropriate management, operational and 
technical safeguards sufficient to protect the confidentiality, 
integrity and availability of the information and information systems 
and to prevent unauthorized access.
    This system will conform to all applicable Federal laws and 
regulations and Federal, HHS, and CMS policies and standards as they 
relate to information security and data privacy. These laws and 
regulations include but are not limited to: the Privacy Act of 1974; 
the Federal Information Security Management Act of 2002; the Computer 
Fraud and Abuse Act of 1986; the Health Insurance Portability and 
Accountability Act of 1996; the E-Government Act of 2002, the Clinger-
Cohen Act of 1996; the Medicare Modernization Act of 2003, and the 
corresponding implementing regulations. OMB Circular A-130, Management 
of Federal Resources, Appendix III, Security of Federal Automated 
Information Resources also applies. Federal, HHS, and CMS policies and 
standards include but are not limited to: All pertinent NIST 
publications; the HHS Information Systems Program Handbook and the CMS 
Information Security Handbook.

V. Effects of the New System on Individual Rights

    CMS proposes to establish this system in accordance with the 
principles and requirements of the Privacy Act and will collect, use, 
and disseminate

[[Page 45400]]

information only as prescribed therein. Data in this system will be 
subject to the authorized releases in accordance with the routine uses 
identified in this system of records.
    CMS will monitor the collection and reporting of Section 1011 data. 
Section 1011 information on patients is submitted to CMS in a standard 
payment system. Accuracy of the data is important since incorrect 
information could result in the wrong payment for services. CMS will 
utilize a variety of onsite and offsite edits and audits to increase 
the accuracy of Section 1011 payment requests.
    CMS will take precautionary measures (see item IV. above) to 
minimize the risks of unauthorized access to the records and the 
potential harm to individual privacy or other personal or property 
rights of patients whose data is maintained in the system. CMS will 
collect only that information necessary to perform the system's 
functions. In addition, CMS will make disclosure from the proposed 
system only with consent of the subject individual, or his/her legal 
representative, or in accordance with an applicable exception provision 
of the Privacy Act.
    CMS, therefore, does not anticipate an unfavorable effect on 
individual privacy as a result of maintaining this system of records.

Charlene Brown,
Chief Operating Officer, Centers for Medicare & Medicaid Services.
SYSTEM NO. 09-70-0546

SYSTEM NAME:
    ``Federal Reimbursement of Emergency Health Services Furnished to 
Undocumented Aliens (Section 1011)'' HHS/CMS/CMM.

SECURITY CLASSIFICATION:
    Level 3, Privacy Act Sensitive.

SYSTEM LOCATION:
    CMS Data Center, 7500 Security Boulevard, North Building, First 
Floor, Baltimore, Maryland 21244-1850 and CMS contractors and agents at 
various locations.

CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:
    The Section 1011 program will include information on individuals 
who have elected to participate in the Section 1011 program, claims 
information related to Section 1011 payment requests, and information 
needed to pay claims and administer the Section 1011 program.

CATEGORIES OF RECORDS IN THE SYSTEM:
    The Section 1011 program includes the provider name and 
identification number, provider address, provider employer 
identification number, provider banking information, provider Federal 
tax identification number, patient's control number, medical record 
number, date of service, patient's gender, zip code, state and county, 
the principle diagnosis code, admitting diagnosis code, and total 
charges. It also includes claims information related to Section 1011 
payment requests, and other research information needed to pay claims 
and administer the Section 1011 program.

AUTHORITY FOR MAINTENANCE OF THE SYSTEM:
    The authority to conduct the program is given under the provisions 
of Section 1011 of the Medicare Prescription Drug, Improvement and 
Modernization Act of 2003 (Pub. L. 108-173).

PURPOSE (S) OF THE SYSTEM:
    The primary purpose of the system is to maintain information 
collected on individuals who submit an enrollment application and make 
payment requests associated with Section 1011 of the MMA, and other 
information designed to support the enrollment, claims payment, and 
research reporting functions of the Section 1011 program. Information 
retrieved from this system will also be disclosed to: (1) Support 
regulatory, payment activities, and policy functions performed within 
the agency or by a designated contractor or consultant; (2) combat 
fraud and abuse in certain health benefits programs; (3) assist another 
Federal or state agency with information to enable such agency to 
administer a Federal health benefits program, or to enable such agency 
to fulfill a requirement of a Federal statute or regulation that 
implements a health benefits program funded in whole or in part with 
Federal; (4) funds support constituent requests made to a Congressional 
representative; and, (5) support litigation involving the agency.

ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES 
OR USERS AND THE PURPOSES OF SUCH USES:
    A. Entities Who May Receive Disclosures Under Routine Use
    These routine uses specify circumstances, in addition to those 
provided by statute in the Privacy Act of 1974, under which CMS may 
release information from the Section 1011 program without the consent 
of the individual to whom such information pertains. Each proposed 
disclosure of information under these routine uses will be evaluated to 
ensure that the disclosure is legally permissible, including but not 
limited to ensuring that the purpose of the disclosure is compatible 
with the purpose for which the information was collected. We are 
proposing to establish the following routine use disclosures of 
information maintained in the system:
    1. To agency contractors or consultants who have been contracted by 
the agency to assist in the performance of a service related to this 
system and who need to have access to the records in order to perform 
the activity.
    2. To a CMS contractor that assists in the administration of a CMS-
administered health benefits program, or to a grantee of a CMS-
administered grant program, when disclosure is deemed reasonably 
necessary by CMS to prevent, deter, discover, detect, investigate, 
examine, prosecute, sue with respect to, defend against, correct, 
remedy, or otherwise combat fraud or abuse in such program.
    3. To another Federal agency or to an instrumentality of any 
governmental jurisdiction within or under the control of the United 
States (including any State or local governmental agency), that 
administers, or that has the authority to investigate potential fraud 
or abuse in, a health benefits program funded in whole or in part by 
Federal funds, when disclosure is deemed reasonably necessary by CMS to 
prevent, deter, discover, detect, investigate, examine, prosecute, sue 
with respect to, defend against, correct, remedy, or otherwise combat 
fraud or abuse in such programs.
    4. To another Federal or State agency to:
    a. Contribute to the accuracy of CMS' proper payment of a health 
benefit, or
    b. Enable such agency to administer a Federal health benefits 
program, or as necessary to enable such agency to fulfill a requirement 
of a Federal statute or regulation that implements a health benefits 
program funded in whole or in part with Federal funds.
    5. To a Member of Congress or to a congressional staff member in 
response to an inquiry of the Congressional Office made at the written 
request of the constituent about whom the record is maintained.
    6. To the Department of Justice (DOJ), court or adjudicatory body 
when:
    a. The agency or any component thereof, or
    b. Any employee of the agency in his or her official capacity; or
    c. Any employee of the agency in his or her individual capacity 
where the DOJ has agreed to represent the employee, or
    d. The United States Government;

[[Page 45401]]

    Is a party to litigation or has an interest in such litigation, and 
by careful review, CMS determines that the records are both relevant 
and necessary to the litigation.
    B. Additional Provisions Affecting Routine Use Disclosures
    This system contains Protected Health Information (PHI) as defined 
by HHS regulation ``Standards for Privacy of Individually Identifiable 
Health Information'' (45 CFR parts 160 and 164, 65 FR 82462 (12-28-00), 
Subparts A and E. Disclosures of PHI authorized by these routine uses 
may only be made if, and as, permitted or required by the ``Standards 
for Privacy of Individually Identifiable Health Information.''
    In addition, our policy will be to prohibit release even of not 
directly identifiable, except pursuant to one of the routine uses or if 
required by law, if we determine there is a possibility that an 
individual can be identified through implicit deduction based on small 
cell sizes (instances where the patient population is so small that 
individuals who are familiar with the enrollees could, because of the 
small size, use this information to deduce the identity of the 
beneficiary).

POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING, 
AND DISPOSING OF RECORDS IN THE SYSTEM:
STORAGE:
    All claim records are stored on magnetic media. Patient eligibility 
information may be maintained electronically or in paper format.

RETRIEVABILITY:
    Providers will retrieve medical records by the patient control 
number. Provider IDs and patient control numbers are used to facilitate 
inquiries into specific claims as needed.

SAFEGUARDS:
    CMS has safeguards in place for authorized users and monitors such 
users to ensure against excessive or unauthorized use. Personnel having 
access to the system have been trained in the Privacy Act and 
information security requirements. Employees who maintain records in 
this system are instructed not to release data until the intended 
recipient agrees to implement appropriate management, operational and 
technical safeguards sufficient to protect the confidentiality, 
integrity and availability of the information and information systems 
and to prevent unauthorized access.
    This system will conform to all applicable Federal laws and 
regulations and Federal, HHS, and CMS policies and standards as they 
relate to information security and data privacy. These laws and 
regulations include but are not limited to: The Privacy Act of 1974; 
the Federal Information Security Management Act of 2002; the Computer 
Fraud and Abuse Act of 1986; the Health Insurance Portability and 
Accountability Act of 1996; the E-Government Act of 2002, the Clinger-
Cohen Act of 1996; the Medicare Modernization Act of 2003, and the 
corresponding implementing regulations. OMB Circular A-130, Management 
of Federal Resources, Appendix III, Security of Federal Automated 
Information Resources also applies. Federal, HHS, and CMS policies and 
standards include but are not limited to: All pertinent NIST 
publications; the HHS Automated Information Systems Security Handbook 
and the CMS Information Security Handbook.

RETENTION AND DISPOSAL:
    CMS will retain identifiable Section 1011 data for an indefinite 
period. Data residing with the designated claims payment contractor 
shall be returned to CMS at the end of the fifth program year, with all 
data then being the responsibility of CMS for adequate storage and 
security.

SYSTEM MANAGER AND ADDRESS:
    Section 1011 Project Officer, Center for Medicare Management, CMS, 
7500 Security Boulevard, Mail Stop C4-10-07, Baltimore, Maryland, 
21244-1850.

NOTIFICATION PROCEDURE:
    For purpose of access, the subject individual should write to the 
system manager who will require the system name, and for verification 
purposes, the subject individual's name and provider identification 
number and the patient's medical record number.

RECORD ACCESS PROCEDURE:
    For purpose of access, use the same procedures outlined in 
Notification Procedures above. Requestors should also reasonably 
specify the record contents being sought. (These procedures are in 
accordance with Department regulation 45 CFR 5b.5(a)(2).)

CONTESTING RECORD PROCEDURES:
    The subject individual should contact the system manager named 
above, and reasonably identify the record and specify the information 
to be contested. State the corrective action sought and the reasons for 
the correction with supporting justification. (These procedures are in 
accordance with Department regulation 45 CFR 5b.7.)

RECORD SOURCE CATEGORIES:
    Information maintained in this system will be collected from 
individuals volunteering to participate in Section 1011 program through 
the enrollment application and claims data requesting payment for 
services.

SYSTEMS EXEMPTED FROM CERTAIN PROVISIONS OF THE ACT:
    None.

[FR Doc. 05-15165 Filed 8-4-05; 8:45 am]
BILLING CODE 4120-03-P