[Federal Register Volume 74, Number 102 (Friday, May 29, 2009)]
[Notices]
[Page 25754]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-12529]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-643 and CMS-359/360]


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

AGENCY: Centers for Medicare & Medicaid Services.
    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: Hospice Survey 
and Deficiencies Report; Use: In order to participate in the Medicare 
program, a hospice must meet certain Federal health and safety 
conditions of participation. This form is used by State surveyors to 
record data about a hospice's compliance with these conditions of 
participation in order to initiate the certification or recertification 
process. Form Number: CMS-643 (OMB: 0938-0379); Frequency: 
Reporting--Yearly; Affected Public: State, Local or Tribal Governments; 
Number of Respondents: 3377; Total Annual Responses: 1130; Total Annual 
Hours: 1130. (For policy questions regarding this collection contact 
Kim Roche at 410-786-3524. For all other issues call 410-786-1326.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Comprehensive 
Outpatient Rehabilitation Facility (CORF) Eligibility and Survey Forms 
and Information Collection Requirements at 42 CFR 485.54 through 
485.66; Use: In order to participate in the Medicare program as a CORF, 
providers must meet Federal conditions of participation. The 
certification form is needed to determine if providers meet at least 
preliminary requirements. The survey form is used to record provider 
compliance with the individual conditions and report findings to CMS. 
Form Number: CMS-359/360/R-55 (OMB: 0938-0267); Frequency: 
Reporting--Occasionally; Affected Public: Private Sector: Business or 
other for-profits; Number of Respondents: 476; Total Annual Responses: 
60; Total Annual Hours: 223,285. (For policy questions regarding this 
collection contact Georgia Johnson at 410-786-6859. For all other 
issues call 410-786-1326.)
    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 29, 2009.

OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk 
Officer, Fax Number: (202) 395-6974, E-mail: [email protected].

    Dated: May 21, 2009.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. E9-12529 Filed 5-28-09; 8:45 am]
BILLING CODE 4120-01-P