[Federal Register Volume 77, Number 49 (Tuesday, March 13, 2012)]
[Notices]
[Pages 14807-14808]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-6035]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-10428]


Emergency Clearance: Public Information Collection Requirements 
Submitted to the Office of Management and Budget (OMB)

AGENCY: Centers for Medicare and 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 and 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 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.
    We are, however, requesting an emergency review of the information 
collection referenced below. In compliance with the requirement of 
section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, we have 
submitted to the Office of Management and Budget (OMB) the following 
requirements for emergency review. We are requesting an emergency 
review to ensure compliance with section 1862(a)(1)(A) of the Social 
Security Act. We cannot reasonably comply with the normal clearance 
procedures in that public harm is reasonably likely to result if normal 
clearance procedures are followed as stated in 5 CFR 1320.13(a)(2)(i).
    1. Type of Information Collection Request: New collection; Title of 
Information Collection: Pre-Existing Condition Insurance Plan (PCIP) 
HIPAA Authorization Form; Use: Unless permitted or required by law, the 
Health Insurance Portability and Accountability Act (HIPAA) privacy 
regulation at 45 CFR 164.508 prohibits CMS' Pre-Existing Condition 
Insurance Plan (PCIP) program (a HIPAA covered entity) from disclosing 
an individual's protected health information without a

[[Page 14808]]

valid authorization. In order to be valid, an authorization must 
include specified core elements and statements. CMS will make available 
to PCIP applicants and enrollees a standard, valid authorization to 
enable beneficiaries to request the disclosure of their protected 
health information. CMS will make available to PCIP applicants and 
enrollees a standard, valid authorization to enable beneficiaries to 
communicate with PCIP about their personal health information. This is 
a critical tool because the population the PCIP program serves is 
comprised of individuals with pre-existing conditions who may be 
incapacitated and need an advocate to help them apply for or receive 
benefits from the program. This standard authorization will simplify 
the process of requesting information disclosure for beneficiaries and 
minimize the response time for the PCIP program; Form Number: CMS-10428 
(OMB 0938-New); Frequency: Occasionally; Affected Public: Private 
Sector (Business or other for-profit and Not-for-profit institutions); 
Number of Respondents: 2,100; Total Annual Responses: 2,100; Total 
Annual Hours: 525. (For policy questions regarding this collection 
contact Laura Dash at 410-786-8623. For all other issues call 410-786-
1326.)
    CMS is requesting OMB review and approval of this collection by 
March 22, 2012. To be assured consideration, comments and 
recommendations for the proposed information collections must be 
received by via one of the methods below on March 19, 2012.
    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.gov/PaperworkReductionActof1995/PRAL/list.asp or Email 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.
    Interested persons are invited to send comments regarding the 
burden or any other aspect of these collections of information 
requirements. However, as noted above, comments on these information 
collection and recordkeeping requirements must be received via one of 
the following methods by March 19, 2012.
    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 
CMS-10417, Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 
21244-1850.

3. By Email to OMB. OMB, Office of Information and Regulatory Affairs, 
Attention: CMS Desk Officer, Email: [email protected].

    Dated: March 8, 2012.
Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2012-6035 Filed 3-12-12; 8:45 am]
BILLING CODE 4120-01-P