[Federal Register Volume 75, Number 227 (Friday, November 26, 2010)]
[Notices]
[Page 72826]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-29718]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-116 and CMS-417]
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: Revision of a currently
approved collection; Title of Information Collection: Clinical
Laboratory Improvement Amendments (CLIA) Application Form and
Supporting Regulations in 42 CFR 493.1-.2001Medicare/Medicaid
Psychiatric Hospital Survey Data; Use: The application must be
completed by entities performing laboratory's testing specimens for
diagnostic or treatment purposes. This information is vital to the
certification process. Form Number: CMS-116 (OMB: 0938-0581);
Frequency: Biennially and Occasionally; Affected Public: Private
Sector: Business or other for-profits and Not-for-profit institutions;
Number of Respondents: 219,000; Total Annual Responses: 31,520; Total
Annual Hours: 23,640. (For policy questions regarding this collection
contact Sheila Ward at 410-786-3115. For all other issues call 410-786-
1326.)
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Hospice Request
for Certification in the Medicare Program; Use: The Hospice Request for
Certification Form is the identification and screening form used to
initiate the certification process and to determine if the provider has
sufficient personnel to participate in the Medicare program. Form
Number: CMS-417 (OMB: 0938-0313); Frequency: Annually;
Affected Public: Private Sector: Business or other for-profits; Number
of Respondents: 3,494; Total Annual Responses: 3,494; Total Annual
Hours: 594. (For policy questions regarding this collection contact
Debbie Terkay at 410-786-6835. 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 December 27,
2010.
OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk
Officer,
Fax Number: (202) 395-6974.
E-mail: [email protected].
Dated: November 18, 2010.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. 2010-29718 Filed 11-24-10; 8:45 am]
BILLING CODE 4120-01-P