[Federal Register Volume 80, Number 220 (Monday, November 16, 2015)]
[Notices]
[Pages 70810-70811]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-29159]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-2567 and CMS-10143]


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: The Centers for Medicare & Medicaid Services (CMS) is 
announcing an opportunity for the public to comment on CMS' intention 
to collect information from the public. Under the Paperwork Reduction 
Act of 1995 (PRA), federal agencies are required to publish notice in 
the Federal Register concerning each proposed collection of 
information, including each proposed extension or reinstatement of an 
existing collection of information, and to allow a second opportunity 
for public comment on the notice. Interested persons are invited to 
send comments regarding the 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

[[Page 70811]]

technology to minimize the information collection burden.

DATES: Comments on the collection(s) of information must be received by 
the OMB desk officer by December 16, 2015.

ADDRESSES: When commenting on the proposed information collections, 
please reference the document identifier or OMB control number. To be 
assured consideration, comments and recommendations must be received by 
the OMB desk officer via one of the following transmissions: OMB, 
Office of Information and Regulatory Affairs, Attention: CMS Desk 
Officer, Fax Number: (202) 395-5806 OR Email: 
[email protected].
    To obtain copies of a supporting statement and any related forms 
for the proposed collection(s) summarized in this notice, you may make 
your request using one of following:
    1. Access CMS' Web site address at http://www.cms.hhs.gov/PaperworkReductionActof1995.
    2. Email your request, including your address, phone number, OMB 
number, and CMS document identifier, to [email protected].
    3. Call the Reports Clearance Office at (410) 786-1326.

FOR FURTHER INFORMATION CONTACT: Reports Clearance Office at (410) 786-
1326.

SUPPLEMENTARY INFORMATION: Under the Paperwork Reduction Act of 1995 
(PRA) (44 U.S.C. 3501-3520), federal agencies must obtain approval from 
the Office of Management and Budget (OMB) for each collection of 
information they conduct or sponsor. The term ``collection of 
information'' is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and 
includes agency requests or requirements that members of the public 
submit reports, keep records, or provide information to a third party. 
Section 3506(c)(2)(A) of the PRA (44 U.S.C. 3506(c)(2)(A)) requires 
federal agencies to publish a 30-day notice in the Federal Register 
concerning each proposed collection of information, including each 
proposed extension or reinstatement of an existing collection of 
information, before submitting the collection to OMB for approval. To 
comply with this requirement, CMS is publishing this notice that 
summarizes the following proposed collection(s) of information for 
public comment:
    1. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
Statement of Deficiencies and Plan of Correction Supporting 
Regulations; Use: Section 1864(a) of the Social Security Act requires 
that the Secretary use state survey agencies to conduct surveys to 
determine whether health care facilities meet Medicare and Clinical 
Laboratory Improvement Amendments participation requirements. The Form 
CMS-2567 is the means by which the survey findings are documented. This 
section of the law further requires that compliance findings resulting 
from these surveys be made available to the public within 90 days of 
such surveys. The Form CMS-2567 is the vehicle for this disclosure. The 
form is also used by health care facilities to document their plan of 
correction and by CMS, the states, facilities, purchasers, consumers, 
advocacy groups, and the public as a source of information about 
quality of care and facility compliance. The regulations at 42 CFR 
488.18 require that state survey agencies document all deficiency 
findings on a statement of deficiencies and plan of correction, which 
is the CMS-2567. Sections 488.26 and 488.28 further delineate how 
compliance findings must be recorded and that CMS prescribed forms must 
be used. Form Number: CMS-2567 (OMB Control Number: 0938-0391); 
Frequency: Yearly and occasionally; Affected Public: Private Sector 
(Business or other for-profit and Not-for-profit institutions); Number 
of Respondents: 64,500; Total Annual Responses: 64,500; Total Annual 
Hours: 128,083. (For policy questions regarding this collection contact 
Karen Tritz at 410-786-8021.)
    2. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Monthly File of 
Medicaid/Medicare Dual Eligible Enrollees; Use: The monthly data file 
is provided to CMS by states on dually eligible Medicaid and Medicare 
beneficiaries, listing the individuals on the Medicaid eligibility 
file, their Medicare status and other information needed to establish 
subsidy level, such as income and institutional status. The file is 
used to count the exact number of individuals who should be included in 
the phased-down state contribution calculation that month. We merge the 
data with other data files and establishes Part D enrollment for those 
individuals on the file. The file may be used by CMS partners to obtain 
accurate counts of duals on a current basis. Form Number: CMS-10143 
(OMB Control Number: 0938-0958); Frequency: Monthly; Affected Public: 
State, Local, or Tribal Governments; Number of Respondents: 51; Total 
Annual Responses: 612; Total Annual Hours: 6,120. (For policy questions 
regarding this collection contact Vasanthi Kandasamy at 410-786-0433).

    Dated: November 10, 2015.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2015-29159 Filed 11-13-15; 8:45 am]
BILLING CODE 4120-01-P