[Federal Register Volume 89, Number 172 (Thursday, September 5, 2024)]
[Notices]
[Page 72402]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-19867]



[[Page 72402]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-10902]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services, Health and Human 
Services (HHS).

ACTION: Notice.

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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 60 days for public comment on 
the proposed action. Interested persons are invited to send comments 
regarding our burden estimates 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 must be received by November 4, 2024.

ADDRESSES: When commenting, please reference the document identifier or 
OMB control number. To be assured consideration, comments and 
recommendations must be submitted in any one of the following ways:
    1. Electronically. You may send 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) that are 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/OMB 
Control Number: ___, Room C4-26-05, 7500 Security Boulevard, Baltimore, 
Maryland 21244-1850.
    To obtain copies of a supporting statement and any related forms 
for the proposed collection(s) summarized in this notice, please access 
the CMS PRA website by copying and pasting the following web address 
into your web browser: https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.

FOR FURTHER INFORMATION CONTACT: William N. Parham at (410) 786-4669.

SUPPLEMENTARY INFORMATION:

Contents

    This notice sets out a summary of the use and burden associated 
with the following information collections. More detailed information 
can be found in each collection's supporting statement and associated 
materials (see ADDRESSES).
CMS-10902 Environmental Health Hazards Checklist Medicare Coverage for 
Individuals Exposed to Environmental Health Hazards

    Under the 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 requires Federal agencies 
to publish a 60-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.

Information Collections

    1. Type of Information Collection Request: New Collection (Request 
for a new OMB control number); Title of Information Collection: 
Environmental Health Hazards Checklist Medicare Coverage for 
Individuals Exposed to Environmental Health Hazards; Use: Section 1881A 
of the Act provides an enrollment basis for individuals who have been 
exposed to environmental health hazards. Currently, the only 
individuals eligible for Medicare under this provision are those who 
were present in Lincoln County, Montana, and have an asbestos-related 
disease (ARD) diagnosis. Eligible individuals must be diagnosed with 
one or more asbestos-related conditions and have been present in 
Lincoln County, Montana, for a total of at least 6 months (need not be 
consecutive) in the period ending 10 years or more before diagnosis of 
an asbestos-related condition. This form provides verification from a 
provider so that SSA can determine eligibility for Medicare enrollment.
    SSA uses this information to determine whether an individual meets 
the requirements for Medicare enrollment on the basis of an 
Environmental Health Hazard. The form is faxed to the applicant's 
provider by SSA. The provider must complete and sign the form and 
submit it back to SSA via fax or mail. The information on the completed 
form is reviewed manually by SSA. Thus, the collection of this 
information does not involve the use of information technology. Form 
Number: CMS-10902 (OMB control number: 0938-New); Frequency: Once; 
Affected Public: Individuals and Households; Number of Respondents: 61; 
Total Annual Responses: 61; Total Annual Hours: 10. (For policy 
questions regarding this collection contact Tyrissa Woods at 410-786-
0286 or [email protected]).

William N. Parham, III,
Director, Division of Information Collections and Regulatory Impacts, 
Office of Strategic Operations and Regulatory Affairs.
[FR Doc. 2024-19867 Filed 9-4-24; 8:45 am]
BILLING CODE 4120-01-P