[Federal Register Volume 72, Number 173 (Friday, September 7, 2007)]
[Notices]
[Pages 51445-51446]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-17625]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-370, 377 and 378]


Agency Information Collection Activities: Proposed Collection; 
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) 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 without change 
of a currently approved collection.
    Title of Information Collection: Health Insurance Benefit 
Agreement, Ambulatory Surgical Centers (ASC) Request for Certification 
in the Medicare Program, ASC Survey Report Form and ASC Conditions of 
Coverage.
    Use: The Health Insurance Benefit Agreement is utilized for the 
purpose of establishing for payment under Title XVIII of the Social 
Security Act. The ASC Request for Certification form is utilized as an 
application for facilities wishing to participate in the Medicare 
program as an ASC. This form initiates the process of obtaining a 
decision as to whether the conditions for coverage are met. It also 
promotes data retrieval from the Online Data Input Edit (ODIE system, a 
subsystem of the Online Survey Certification and Report

[[Page 51446]]

(OSCAR) system by CMS Regional Offices (ROs). The ASC Report Form is an 
instrument used by the State survey agency to record data collection in 
order to determine supplier compliance with individual conditions for 
coverage and report it to the Federal Government. The form is primarily 
a coding worksheet designed to facilitate data reduction and retrieval 
into the ODIE/OSCAR system at the CMS ROs. This form includes basic 
information on compliance (i.e., met, not met and explanatory 
statements) and does not require any descriptive information regarding 
the survey activity itself.
    Form Numbers: CMS-370, 377, 378 (OMB: 0938-0266).
    Frequency: Reporting--Occasionally (initially and then every 3 
years).
    Affected Public: States, Local or Tribal Governments.
    Number of Respondents: 5123.
    Total Annual Responses: 1707.
    Total Annual Hours: 2,787.
    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/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 at the address below, 
no later than 5 p.m. on November 6, 2007.
    CMS, Office of Strategic Operations and Regulatory Affairs, 
Division of Regulations Development--A, Attention: Melissa Musotto, 
Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

    Dated: August 30, 2007.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
 [FR Doc. E7-17625 Filed 9-6-07; 8:45 am]
BILLING CODE 4120-01-P