[Federal Register Volume 75, Number 141 (Friday, July 23, 2010)]
[Notices]
[Pages 43167-43168]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-17899]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-R-249, CMS-1561 and CMS-R-308]


Agency Information Collection Activities: Proposed Collection; 
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) 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 of a currently 
approved collection; Title of Information Collection: Hospice Cost and 
Data Report and supporting regulations 42 CFR 413.20 and 42 CFR 413.24; 
Use: In accordance with sections 1815(a), 1833(e), and 1861(v)(A)(ii) 
of the Social Security Act, providers of service in the Medicare 
program are required to submit annual information to achieve 
reimbursement for health care services rendered to Medicare 
beneficiaries. In addition, 42 CFR 413.20(b) sets forth that cost 
reports will be required from providers on an annual basis. Such cost 
reports are required to be filed with the provider's fiscal 
intermediary (FI) or Medicare Administrative Contractor (MAC) no later 
than the last day of the fifth month following the close of the period 
covered by the report. Form Number: CMS-R-249 (OMB: 0938-
0758); Frequency: Yearly; Affected Public: Business or other for-
profits and not-for-profit institutions; Number of Respondents: 2,303; 
Total Annual Responses: 2,303; Total Annual Hours: 405,328. (For policy 
questions regarding this collection contact Gail Duncan at 410-786-
7278. For all other issues call 410-786-1326.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Health Insurance 
Benefit Agreement; Use: Applicants to the Medicare program are required 
to agree to provide services in accordance with Federal requirements. 
The CMS-1561 is essential for CMS to ensure that applicants are in 
compliance with the requirements. Applicants will be required to sign 
the completed form and provide operational information to CMS to assure 
that they continue to meet the requirements after approval. Form 
Number: CMS-1561 (OMB: 0938-0832); Frequency: Yearly; Affected 
Public: Private Sector: Business or other for-profits and not-for-
profit institutions; Number of Respondents: 3,000; Total Annual 
Responses: 3,000; Total Annual Hours: 500. (For policy questions 
regarding this collection contact JoAnn Perry at 410-786-3336. For all 
other issues call 410-786-1326.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Children's Health 
Insurance Program; Use: States are required to submit title XXI plans 
and amendments for approval by the

[[Page 43168]]

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. States are also required to submit State 
expenditure and statistical reports, annual reports and State 
evaluations to the Secretary as outlined in title XXI of the Social 
Security Act. Form Number: CMS-R-308 (OMB: 0938-0841); 
Frequency: Yearly, quarterly, once and/or occasionally; Affected 
Public: State, Local, or Tribal Governments; Number of Respondents: 56; 
Total Annual Responses: 1,114,124; Total Annual Hours: 864,973. (For 
policy questions regarding this collection contact Nancy Goetschius at 
410-786-0707. 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 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.
    In commenting on the proposed information collections please 
reference the document identifier or OMB control number. To be assured 
consideration, comments and recommendations must be submitted in one of 
the following ways by September 21, 2010:
    1. Electronically. You may submit your comments electronically to 
http://www.regulations.gov. Follow the instructions for ``Comment or 
Submission'' or ``More Search Options'' to find the information 
collection document(s) accepting comments.
    2. By regular mail. You may mail written comments to the following 
address:
    CMS, Office of Strategic Operations and Regulatory Affairs, 
Division of Regulations Development, Attention: Document Identifier/OMB 
Control Number, Room C4-26-05, 7500 Security Boulevard, Baltimore, 
Maryland 21244-1850.

    Dated: July 19, 2010.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 2010-17899 Filed 7-22-10; 8:45 am]
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