[Federal Register Volume 70, Number 246 (Friday, December 23, 2005)]
[Notices]
[Pages 76289-76290]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-24302]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS R-193 and CMS-2567]


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 
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: Important Message 
from Medicare Title XVII Section 1866(a)(1)(M), 42 CFR Sections 466.78, 
489.20, and 489.27; Form Number: CMS-R-193 (OMB: 0938-0692); 
Use: Hospitals participating in the Medicare program are required to 
distribute the ``Important Message From Medicare'' to all Medicare 
beneficiaries (including those enrolled in a Medicare managed care 
health plan). Hospitals must distribute this notice at or about the 
same time of a Medicare beneficiary's admission or during the course of 
his or her hospital stay. Receiving this information will provide all 
Medicare beneficiaries with some ability to participate and/or initiate 
discussions concerning actions that may affect their Medicare coverage, 
payment, and appeal rights in response to a hospital's or Medicare 
managed care plan's notification that their care will no longer 
continue; Frequency: Recordkeeping and Reporting--Other: Distribution; 
Affected Public: Individuals or Households, Business or other for-
profit, Not-for-profit institutions, Federal, State, Local or Tribal 
Government; Number of Respondents: 6,051; Total Annual Responses: 
12,500,000; Total Annual Hours: 208,333.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Statement of 
Deficiencies and Plan of Correction contained under 42 CFR 488.18, 
488.26, and 488.28; Form Number: CMS-2567 (OMB: 0938-0391); 
Use: Section 1864(a) of the Social Security Act requires that the 
Secretary use State survey agencies to conduct surveys. The surveys are 
used to determine if health care facilities meet Medicare, Medicaid, 
and Clinical Laboratory Improvement Amendments (CLIA) participation 
requirements. The Statement of Deficiencies and Plan of Correction 
form, is used to record each deficiency discovered during an 
inspection. Providers, suppliers and CLIA laboratories also utilize 
this form to outline a corrective action plan for each deficiency. The 
States and CMS regional offices use this form to document and certify 
compliance, and to disclose information to the public; Frequency: 
Recordkeeping, Third party disclosure and Reporting--Annually and 
Biennially; Affected Public: Business or other for-profit, Not-for-
profit institutions, Federal, State, Local or Tribal Government; Number 
of Respondents: 60,000; Total Annual Responses: 60,000; Total Annual 
Hours: 120,000.
    To obtain copies of the supporting statement and any related forms 
for these 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.

[[Page 76290]]

    To be assured consideration, comments and recommendations for the 
proposed information collections must be received by the OMB Desk 
Officer at the address below, no later than 5 p.m. on January 23, 2006. 
OMB Human Resources and Housing Branch, Attention: Carolyn Lovett, CMS 
Desk Officer, New Executive Office Building, Room 10235, Washington, DC 
20503.

    Dated: December 14, 2005.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 05-24302 Filed 12-22-05; 8:45 am]
BILLING CODE 4120-01-P