[Federal Register Volume 73, Number 101 (Friday, May 23, 2008)]
[Notices]
[Pages 30106-30107]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-11397]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-R-211, CMS-10258, CMS-209, CMS-10259, CMS-R-
266, and CMS-R-306]


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: Model Application 
Template for State Child Health Plan Under Title XXI of the Social 
Security Act, State Children's Health Insurance Program, Instructions 
for Model Application Template; Use: States are required to submit 
Title XXI plans and amendments for approval by the Secretary pursuant 
to section 2102 of the Social Security Act in order to receive funds 
for initiating and expanding health insurance coverage for uninsured 
children. The model application template is used to assist States in 
submitting a State Child Health Plan and amendments to that plan. Form 
Number: CMS-R-211 (OMB 0938-0707); Frequency: Yearly and 
occasionally; Affected Public: State, Local or Tribal Governments; 
Number of Respondents: 56; Total Annual Responses: 40; Total Annual 
Hours: 3,200.
    2. Type of Information Collection Request: New collection; Title of 
Information Collection: Survey of State Medicaid Agencies: Innovative 
Approaches to Collecting Citizenship Documentation; Use: The purpose of 
the survey is to collect information from State Medicaid agencies on 
innovative approaches used to collect citizenship documentation from 
Medicaid applicants and recipients. Prior to the Deficit Reduction Act 
of 2005 (DRA), Medicaid applicants could self-attest to citizenship. As 
of July 1, 2006, applicants and recipients are required to provide 
original documentation of citizenship. For some states, this new 
requirement is challenging because there has been a general movement 
towards virtual applications by phone, mail, or online submission. CMS 
is using this survey to identify innovative ways that states have taken 
advantage of existing information within the state system such as 
matching data, forming unique partnerships, or holding training 
sessions to facilitate effective and efficient collection of 
citizenship documentation. CMS will use the information collected with 
the survey to compile a snapshot of the innovative and unique 
approaches states are employing to meet the citizenship documentation 
requirements of the DRA. The results will be incorporated into a final 
comprehensive report that will be used as an outreach tool that will 
then be distributed to states. Form Number: CMS-10258 (OMB 
0938-NEW); Frequency: Once; Affected Public: State, Local or Tribal 
Governments; Number of Respondents: 100; Total Annual Responses: 100; 
Total Annual Hours: 25.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Laboratory 
Personnel Report (CLIA) and Supporting Regulations in 42 CFR 493.1--
493.2001; Use: This form is used by the State agency to determine a 
laboratory's compliance with personnel qualifications under CLIA. This 
information is needed for a laboratory's CLIA certification and 
recertification. Form Number: CMS-209 (OMB 0938-0151); 
Frequency: Biennially; Affected Public: Private Sector: Business or 
other

[[Page 30107]]

for-profits, not-for-profit institutions; State, Local or Tribal 
Governments; and Federal Government. Number of Respondents: 21,000; 
Total Annual Responses: 10,500; Total Annual Hours: 5,248.
    4. Type of Information Collection Request: New collection; Title of 
Information Collection: State Plan Amendment template for 1915(i) State 
Plan Home and Community-Based Services (HCBS) Benefit; Use: Section 
6086 of the Deficit Reduction Act (DRA), expanded access to HCBS for 
the elderly and disabled and added a new section 1915(i) to the Social 
Security Act. Under 1915(i), States can amend their State plans to add 
these services. The template includes the information needed by CMS to 
determine whether the State's services will meet the requirements under 
1915(i). Form Number: CMS-10259 (OMB 0938-NEW); Frequency: 
Once; Affected Public: State, Local or Tribal Governments; Number of 
Respondents: 56; Total Annual Responses: 3; Total Annual Hours: 240.
    5. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicaid 
Disproportionate Share Hospital Annual Reporting; Use: Section 
1923(j)(i) of the Social Security Act requires States to submit an 
annual report that identifies each disproportionate share hospital 
(DSH) that received a DSH payment under the State's Medicaid program in 
the preceding fiscal year and the amount of DSH payments paid to that 
hospital in the same year and such other information as the Secretary 
determines necessary to ensure the appropriateness of DSH payments. The 
information supplied will satisfy the requirements under section 
1923(a)(2)(D) of the Act as well. Form Number: CMS-R-266 (OMB 
0938-0746); Frequency: Yearly; Affected Public: State, Local or Tribal 
Governments; Number of Respondents: 52; Total Annual Responses: 52; 
Total Annual Hours: 1976.
    6. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Use of Restraint 
and Seclusion in Psychiatric Residential Treatment Facilities (PRTFs) 
for Individuals Under Age 21; Use: PRTFs are required to report deaths, 
serious injuries and attempted suicides to the State Medicaid Agency 
and the Protection and Advocacy Organization. They are also required to 
provide residents the restraint and seclusion policy in writing, and to 
document in the residents' records all activities involving the use of 
restraint and seclusion. Form Number: CMS-R-306 (OMB 0938-
0833); Frequency: Annually; Affected Public: Private Sector: Business 
or other for-profits; Number of Respondents: 500; Total Annual 
Responses: 329,500; Total Annual Hours: 501,750.
    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 by the OMB desk 
officer at the address below, no later than 5 p.m. on June 23, 2008: 
OMB Human Resources and Housing Branch, Attention: Carolyn Raffaelli, 
New Executive Office Building, Room 10235, Washington, DC 20503, Fax 
Number: (202) 395-6974.

    Dated: May 14, 2008.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. E8-11397 Filed 5-22-08; 8:45 am]
BILLING CODE 4120-01-P