[Federal Register Volume 74, Number 195 (Friday, October 9, 2009)]
[Notices]
[Page 52238]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-24233]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier CMS-10287]


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: New collection; Title of 
Information Collection: Medicare Quality of Care Complaint Form; Use: 
In accordance with section 1154(a)(14) of the Social Security Act, 
Quality Improvement Organizations (QIOs) are required to conduct 
appropriate reviews of all written complaints submitted by 
beneficiaries concerning the quality of care received. The Medicare 
Quality of Care Complaint Form will be used by Medicare beneficiaries 
to submit quality of care complaints. This form will establish a 
standard form for all beneficiaries to utilize and ensure pertinent 
information is obtained by QIOs to effectively process these 
complaints. Form Number: CMS-10287 (OMB: 0938-New); Frequency: 
Reporting--On occasion; Affected Public: Individuals or Households; 
Number of Respondents: 3,500; Total Annual Responses: 3,500; Total 
Annual Hours: 583. (For policy questions regarding this collection 
contact Tom Kessler at 410-786-1991. 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 November 9, 2009.

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

    Dated: October 1, 2009.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. E9-24233 Filed 10-8-09; 8:45 am]
BILLING CODE 4120-01-P