[Federal Register Volume 71, Number 18 (Friday, January 27, 2006)]
[Notices]
[Pages 4583-4584]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 06-605]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-1557, CMS-R-0074, CMS-416, CMS-437A and 437B]


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: Survey Report 
Form Clinical Laboratory Improvement Amendments (CLIA) and supporting 
regulations under 42 CFR 493.1-493.2001; Form Number: CMS-1557 
(OMB: 0938-0544); Use: This form is used by the State agency 
to determine a laboratory's compliance with CLIA. This information is 
needed for a laboratory's CLIA certification and recertification; 
Frequency: Recordkeeping and Reporting--Biennially; Affected Public: 
Business or other for-profit, Not-for-profit institutions, Federal, 
State, Local or Tribal Government; Number of Respondents: 25,000; Total 
Annual Responses: 12,500; Total Annual Hours: 6,250.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Income and 
Eligibility Verification System Reporting in Section 1137 of the Social 
Security Act and Supporting Regulations in 42 CFR 431.17, 431.306, 
435.910, 435.920, 435.940-435.960; Form Number: CMS-R-0074 
(OMB: 0938-0467); Use: This information is used to verify the 
income and eligibility of Medicaid applicants and recipients as 
required by Section 1137 of the Social Security Act; Affected Public: 
Individuals or Households and State, Local or Tribal Government; Number 
of Respondents: 54; Total Annual Responses: 54; Total Annual Hours: 
124,054.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Annual Early and 
Periodic Screening, Diagnostic and Treatment Services (EPSDT) 
Participation Report; Form No.: CMS-416 (OMB 0938-0354); Use: 
States are required to submit an annual report on the provision of 
EPSDT services to CMS pursuant to section 1902(1)(43)(D) of the Social 
Security Act. These reports provide CMS with data necessary to assess 
the effectiveness of State EPSDT programs, to determine a state's 
results in achieving its participation goal, and to respond to 
inquiries; Frequency:

[[Page 4584]]

Annually; Affected Public: State, Local or Tribal Government; Number of 
Respondents: 56; Total Annual Responses: 56; Total Annual Hours: 1,568.
    4. Type of Information Collection Request: New Collection; Title of 
Information Collection: Rehabilitation Unit Criteria Work Sheet and 
Rehabilitation Hospital Criteria Work Sheet and Supporting Regulations 
at 42 CFR 488.26; Form Number: CMS-437A and CMS-437B (OMB: 
0938-NEW--NOTE: These instruments are currently approved under 0938-
0358 but are being carved out into a separate collection as they are 
updated more frequently.); Use: The rehabilitation hospital and 
rehabilitation unit criteria work sheets are necessary to verify that 
these facilities/units comply and remain in compliance with the 
exclusion criteria for the Medicare prospective payment system; 
Frequency: Annually; Affected Public: Business or other-for-profit, 
Not-for-profit institutions, and State, Local, or Tribal Government; 
Number of Respondents: 1227; Total Annual Responses: 1227; Total Annual 
Hours: 306.75.
    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/PaperworkReductionActof1995, 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.
    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 February 27, 
2006. OMB Human Resources and Housing Branch, Attention: Brenda 
Aguilar, CMS Desk Officer, New Executive Office Building, Room 10235, 
Washington, DC 20503.

    Dated: January 12, 2006.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 06-605 Filed 1-26-06; 8:45 am]
BILLING CODE 4120-01-P