[Federal Register Volume 77, Number 65 (Wednesday, April 4, 2012)]
[Notices]
[Pages 20405-20406]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-8011]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-372(S), CMS-R-306, CMS-10180 and CMS-R-199]


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: Reinstatement without 
change of a currently approved collection; Title of Information 
Collection: Annual Report on Home and Community Based Services Waivers 
and Supporting Regulations in 42 CFR 440.180 and 441.300-310; Use: CMS 
is asking the States to report financial and statistical information 
concerning the numbers of Medicaid beneficiaries receiving waiver 
services, the type of services provided and the costs of those 
services. The information is usually taken from State Medicaid agency 
data processing systems. This data is summarized and may be submitted 
to CMS through the 372 web-based form. The report is used by CMS to 
compare actual data in the approved waiver estimates and, in 
conjunction with the waiver compliance review reports, the information 
provided is compared to that in the Medicaid Statistical Information 
System (CMS-R-284, OCN 0938-0345) report and Federal financial 
participation claimed on a State's Quarterly Expenditure Report (CMS-
64, OCN 0938-0067), to determine whether to continue the State's home 
and community-based services waiver. States' estimates of cost and 
utilization for renewal purposes are based upon the data compiled in 
the CMS Form 372(S) reports. There have been no changes to the PRA 
package that is associated with the 60-day notice that published on 
January 24, 2012 (77 FR 3477); Form Number: CMS-372(S) (OCN 0938-0272); 
Frequency: Yearly; Affected Public: State, Local, or Tribal 
Governments; Number of Respondents: 49; Total Annual Responses: 305; 
Total Annual Hours: 13,115. (For policy questions regarding this 
collection contact Ralph Lollar at 410-786-0777. 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: Condition of Participation--Use of Restraint and Seclusion 
in Psychiatric Residential Treatment Facilities Providing Psychiatric 
Services to Individuals Under Age 21 and Supporting Regulations at 42 
CFR 483.350-483.376; Use: Psychiatric Residential Treatment Facilities 
are required to report deaths, serious injuries and attempted suicides 
to the State Medicaid Agency and the Protection and Advocacy 
Organization. They are also required to provide residents the restraint 
and seclusion policy in writing, and to document in the residents' 
records all activities involving the use of restraint and seclusion. 
There have been no changes to the PRA package that is associated with 
the 60-day notice that published on January 13, 2012 (77 FR 2067); Form 
Number: CMS-R-306 (OCN 0938-0833); Frequency: Once and Occasionally; 
Affected Public: Private Sector (Business or other for-profits); Number 
of Respondents: 376; Total Annual Responses: 329,500; Total Annual 
Hours: 501,750. (For policy questions regarding this collection contact 
Jean Close at 410-786-2804 or Melissa Musotto at 410-786-6962. 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 (CHIP) Report on Payables and Receivables; Use: 
Collection of CHIP data and the calculation of the CHIP Incurred But 
Not Reported (IBNR) estimate are pertinent to CMS' financial audit. The 
CFO auditors have reported the lack of an estimate for CHIP IBNR 
payables and receivables as a reportable condition in the FY 2005 audit 
of CMS's financial statements. It is essential that CMS collect the 
necessary data from State agencies in FY 2006, so that CMS continues to 
receive an unqualified audit opinion on its financial statements. 
Program expenditures for the CHIP have increased since its inception; 
as such, CHIP receivables and payables may materially impact the 
financial statements. The CHIP Report on Payables and Receivables will 
provide the information needed to calculate the CHIP IBNR; Form Number: 
CMS-10180 (OMB: 0938-0988); Frequency: Reporting--Annually; 
Affected Public: State, Local or Tribal governments; Number of 
Respondents: 56; Total Annual Responses: 56; Total Annual Hours: 392. 
(For policy questions regarding this collection contact Michele Myers 
at 410-786-7911. For all other issues call 410-786-1326.)
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicaid Report 
on Payables and Receivables; Use: The Chief Financial Officers (CFO) 
Act of 1990, as amended by the Government Management Reform Act (GMRA) 
of 1994, requires government agencies to produce auditable financial 
statements. Because the Centers for Medicare & Medicaid Services (CMS) 
fulfills its mission through its contractors and the States, these 
entities are the primary source of information for the financial 
statements. There are three basic categories of data: Expenses, 
payables, and receivables. The CMS-64 is used to collect data on 
Medicaid expenses. The CMS-R-199 collects Medicaid payable and 
receivable accounting data from the States. Form Number: CMS-R-199 
(OMB: 0938-0697); Frequency: Reporting--Annually; Affected 
Public: State, Local or Tribal governments; Number of Respondents: 56; 
Total Annual Responses: 56; Total Annual Hours: 336. (For policy 
questions regarding this collection contact Michele Myers at 410-786-
7911. 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 
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.
    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 May 4, 2012.


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

    Dated: March 28, 2012.
Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2012-8011 Filed 4-3-12; 8:45 am]
BILLING CODE 4120-01-P