[Federal Register Volume 74, Number 136 (Friday, July 17, 2009)]
[Notices]
[Pages 34757-34758]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-17080]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10284, CMS-2567 and CMS-10283]


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

AGENCY: Centers for Medicare & Medicaid Services, Department of Health 
and Human 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.

[[Page 34758]]

    1. Type of Information Collection Request: New Collection; Title of 
Information Collection: Children's Health Insurance Program 
Reauthorization Act (CHIPRA) of 2009, State Option Pre-print to Include 
Pregnant Women in Title XXI; Use: Section 111 of CHIPRA adds a new 
section 2112 to the Social Security Act which gives States the option 
of providing necessary prenatal, delivery and postpartum care to low-
income uninsured pregnant women through an amendment to its State Child 
Health Plan (CHIP plan). The purpose of this draft State plan amendment 
template is to provide States with the format needed to enable a State 
to amend their CHIP plan to reflect the coverage of pregnant women. 
Form Number: CMS-10284 (OMB: 0938-NEW); Frequency: Reporting--
One-time and Occasionally; Affected Public: State, Local or Tribal 
Government; Number of Respondents: 40; Total Annual Responses: 40; 
Total Annual Hours: 3,200. (For policy questions regarding this 
collection contact Meredith Robertson at 410-786-6543. For all other 
issues call 410-786-1326.)
    2. Type of Information Collection Request: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Statement of Deficiencies and Plan of Correction; Use: The 
information from the CMS-2567 is used by the States and CMS regional 
offices to document and certify compliance. Form Number: CMS-2567 
(OMB: 0938-0391); Frequency: Reporting--Annually; Affected 
Public: State, Local or Tribal Government, Federal Government, Business 
or other for-profits and Not-for-profit Institutions; Number of 
Respondents: 60,000; Total Annual Responses: 60,000; Total Annual 
Hours: 120,000. (For policy questions regarding this collection contact 
Joanne Perry at 410-786-3336. For all other issues call 410-786-1326.)
    3. Type of Information Collection Request: New Collection; Title of 
Information Collection: State Plan Amendment Template for Transitional 
Medical Assistance for Low-Income Families; Use: Section 5004 of the 
American Recovery and Reinvestment Act of 2009, Public Law 111-5, 
amends section 1925 of the Social Security Act effective July 1, 2009 
to offer States two new options for eligibility requirements under 
Transitional Medical Assistance. To select either or both of these 
options a State Medicaid Agency will complete the template page and 
submit it for approval as part of a State plan amendment. The law also 
imposes new reporting requirements for States which are mentioned on 
the template. Form Number: CMS-10283 (OMB: 0938-NEW); 
Frequency: Reporting--One-time and Occasionally; Affected Public: 
State, Local or Tribal Government; Number of Respondents: 51; Total 
Annual Responses: 51; Total Annual Hours: 51. (For policy questions 
regarding this collection contact Mary Corddry at 410-786-6618. 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 August 17, 2009: 
OMB, Office of Information and Regulatory Affairs Attention: CMS Desk 
Officer, Fax Number: (202) 395-6974.
    E-mail: [email protected].

    Dated: July 9, 2009.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. E9-17080 Filed 7-16-09; 8:45 am]
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