[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