[Federal Register Volume 82, Number 121 (Monday, June 26, 2017)]
[Notices]
[Pages 28851-28852]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-13321]


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

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-1561/1561A, CMS-370 and CMS-377]


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

AGENCY: Centers for Medicare & Medicaid Services, HHS.

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 the necessity and utility of the 
proposed information collection for the proper performance of the 
agency's functions, the accuracy of the estimated burden, ways to 
enhance the quality, utility, and clarity of the information to be 
collected; and the use of automated collection techniques or other 
forms of information technology to minimize the information collection 
burden.

DATES: Comments on the collection(s) of information must be received by 
the OMB desk officer by July 26, 2017.

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 Web site address at https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html.
    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: William Parham at (410) 786-4669.

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, revision 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 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-1561/1561A is essential in that is allows us to ensure that 
applicants are in compliance with the requirements. Applicants will be 
required to sign the completed form and provide operational information 
to us to assure that they continue to meet the requirements after 
approval. Form Number: CMS-1561/1561A (OMB control number: 0938-0832); 
Frequency: Yearly; Affected Public: Private sector--(Business or other 
for-profits and Not-for-profit institutions); Number of Respondents: 
2,400; Total Annual Responses: 2,400; Total Annual Hours: 400. (For 
policy questions regarding this collection contact Shonte Carter at 
410-786-3532).
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Titles of Information Collection: ASC Forms for 
Medicare Program Certification; Use: The CMS-370 is used to establish 
eligibility for payment. This agreement, upon submission by the 
ambulatory surgical center (ASC) and acceptance for filing by the 
Secretary of Health & Human Services, shall be binding on both the ASC 
and the Secretary. The agreement may be terminated by either party in 
accordance with regulations. In the event of termination, payment will 
not be available for ASC services furnished on or after the effective 
date of termination.
    The Request for Certification or Update of Certification 
Information in

[[Page 28852]]

the Medicare Program Form (CMS-377) is used by State agencies who 
conduct certification surveys on CMS' behalf to maintain information on 
the facility's characteristics that facilitate conducting surveys, 
e.g., determining the size and the composition of the survey team on 
the basis of the number of ORs/procedure rooms and the types of 
surgical procedures performed in the ASC. Form Numbers: CMS-370 and 
CMS-377 (OMB control number: 0938-0266); Frequency: Occasionally; 
Affected Public: Private Sector--Business or other for-profit and Not-
for-profit institutions; Number of Respondents: 5,694; Total Annual 
Responses: 1,898; Total Annual Hours: 627. (For policy questions 
regarding this collection contact Erin McCoy at 410-786-2337.)

    Dated: June 21, 2017.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2017-13321 Filed 6-23-17; 8:45 am]
 BILLING CODE 4120-01-P