82 FR 28851 - Agency Information Collection Activities: Submission for OMB Review; Comment Request
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services Federal Register Volume 82, Issue 121 (June 26, 2017)
Centers for Medicare & Medicaid Services
Federal Register Volume 82, Issue 121 (June 26, 2017)
| Page Range | 28851-28852 | |
| FR Document | 2017-13321 |
[Federal Register Volume 82, Number 121 (Monday, June 26, 2017)] [Notices] [Pages 28851-28852] From the Federal Register Online [www.thefederalregister.org] [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
![Federal Register / Vol. 82, No. 121 / Monday, June 26, 2017 / Notices 28851
cost to respondents other than the time The total estimated burden for all of hours of burden for a maximum of 15
to participate in information collection. the information collections is not potentially PRA-applicable contracts).
expected to exceed 1,500 hours (100
ESTIMATED ANNUALIZED BURDEN HOURS
Average
Number of
Number of burden per Total burden
Type of respondents Form name responses per
respondents response (in hrs.)
respondent (in hrs.)
Public ................................................ Information Collection ....................... 150 1 1 1,500
Total ........................................... ........................................................... ........................ ........................ ........................ 1,500
Leroy A. Richardson, DATES: Comments on the collection(s) of revision or reinstatement of an existing
Chief, Information Collection Review Office, information must be received by the collection of information, before
Office of Scientific Integrity, Office of the OMB desk officer by July 26, 2017. submitting the collection to OMB for
Associate Director for Science, Office of the ADDRESSES: When commenting on the approval. To comply with this
Director, Centers for Disease Control and requirement, CMS is publishing this
Prevention.
proposed information collections,
please reference the document identifier notice that summarizes the following
[FR Doc. 2017–13320 Filed 6–23–17; 8:45 am] proposed collection(s) of information for
or OMB control number. To be assured
BILLING CODE 4163–18–P
consideration, comments and public comment:
recommendations must be received by 1. Type of Information Collection
the OMB desk officer via one of the Request: Extension of a currently
DEPARTMENT OF HEALTH AND approved collection; Title of
following transmissions: OMB, Office of
HUMAN SERVICES Information Collection: Health
Information and Regulatory Affairs,
Attention: CMS Desk Officer, Fax Insurance Benefit Agreement; Use:
Centers for Medicare & Medicaid Applicants to the Medicare program are
Services Number: (202) 395–5806 OR, Email:
OIRA_submission@omb.eop.gov. required to agree to provide services in
[Document Identifier: CMS–1561/1561A, To obtain copies of a supporting accordance with federal requirements.
CMS–370 and CMS–377] statement and any related forms for the The CMS–1561/1561A is essential in
proposed collection(s) summarized in that is allows us to ensure that
Agency Information Collection this notice, you may make your request applicants are in compliance with the
Activities: Submission for OMB using one of following: requirements. Applicants will be
Review; Comment Request 1. Access CMS’ Web site address at required to sign the completed form and
Web site address at https:// provide operational information to us to
AGENCY: Centers for Medicare & assure that they continue to meet the
Medicaid Services, HHS. www.cms.gov/Regulations-and-
Guidance/Legislation/ requirements after approval. Form
ACTION: Notice. Number: CMS–1561/1561A (OMB
PaperworkReductionActof1995/PRA-
Listing.html. control number: 0938–0832); Frequency:
SUMMARY: The Centers for Medicare & Yearly; Affected Public: Private sector—
Medicaid Services (CMS) is announcing 2. Email your request, including your
address, phone number, OMB number, (Business or other for-profits and Not-
an opportunity for the public to for-profit institutions); Number of
comment on CMS’ intention to collect and CMS document identifier, to
Paperwork@cms.hhs.gov. Respondents: 2,400; Total Annual
information from the public. Under the Responses: 2,400; Total Annual Hours:
Paperwork Reduction Act of 1995 3. Call the Reports Clearance Office at
(410) 786–1326. 400. (For policy questions regarding this
(PRA), federal agencies are required to collection contact Shonte Carter at 410–
publish notice in the Federal Register FOR FURTHER INFORMATION CONTACT:
786–3532).
concerning each proposed collection of William Parham at (410) 786–4669. 2. Type of Information Collection
information, including each proposed SUPPLEMENTARY INFORMATION: Under the Request: Extension of a currently
extension or reinstatement of an existing Paperwork Reduction Act of 1995 (PRA) approved collection; Titles of
collection of information, and to allow (44 U.S.C. 3501–3520), federal agencies Information Collection: ASC Forms for
a second opportunity for public must obtain approval from the Office of Medicare Program Certification; Use:
comment on the notice. Interested Management and Budget (OMB) for each The CMS–370 is used to establish
persons are invited to send comments collection of information they conduct eligibility for payment. This agreement,
regarding the burden estimate or any or sponsor. The term ‘‘collection of upon submission by the ambulatory
other aspect of this collection of information’’ is defined in 44 U.S.C. surgical center (ASC) and acceptance for
information, including the necessity and 3502(3) and 5 CFR 1320.3(c) and filing by the Secretary of Health &
utility of the proposed information includes agency requests or Human Services, shall be binding on
collection for the proper performance of requirements that members of the public both the ASC and the Secretary. The
the agency’s functions, the accuracy of submit reports, keep records, or provide
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agreement may be terminated by either
the estimated burden, ways to enhance information to a third party. Section party in accordance with regulations. In
the quality, utility, and clarity of the 3506(c)(2)(A) of the PRA (44 U.S.C. the event of termination, payment will
information to be collected; and the use 3506(c)(2)(A)) requires federal agencies not be available for ASC services
of automated collection techniques or to publish a 30-day notice in the furnished on or after the effective date
other forms of information technology to Federal Register concerning each of termination.
minimize the information collection proposed collection of information, The Request for Certification or
burden. including each proposed extension, Update of Certification Information in
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![28852 Federal Register / Vol. 82, No. 121 / Monday, June 26, 2017 / Notices
the Medicare Program Form (CMS–377) collected, and the use of automated approval from the Office of Management
is used by State agencies who conduct collection techniques or other forms of and Budget (OMB) for each collection of
certification surveys on CMS’ behalf to information technology to minimize the information they conduct or sponsor.
maintain information on the facility’s information collection burden. The term ‘‘collection of information’’ is
characteristics that facilitate conducting DATES: Comments must be received by defined in 44 U.S.C. 3502(3) and 5 CFR
surveys, e.g., determining the size and August 25, 2017. 1320.3(c) and includes agency requests
the composition of the survey team on ADDRESSES: When commenting, please or requirements that members of the
the basis of the number of ORs/ reference the document identifier or public submit reports, keep records, or
procedure rooms and the types of OMB control number. To be assured provide information to a third party.
surgical procedures performed in the consideration, comments and Section 3506(c)(2)(A) of the PRA
ASC. Form Numbers: CMS–370 and recommendations must be submitted in requires federal agencies to publish a
CMS–377 (OMB control number: 0938– any one of the following ways: 60-day notice in the Federal Register
0266); Frequency: Occasionally; 1. Electronically. You may send your concerning each proposed collection of
Affected Public: Private Sector— comments electronically to http:// information, including each proposed
Business or other for-profit and Not-for- www.regulations.gov. Follow the extension or reinstatement of an existing
profit institutions; Number of instructions for ‘‘Comment or collection of information, before
Respondents: 5,694; Total Annual Submission’’ or ‘‘More Search Options’’ submitting the collection to OMB for
Responses: 1,898; Total Annual Hours: to find the information collection approval. To comply with this
627. (For policy questions regarding this document(s) that are accepting requirement, CMS is publishing this
collection contact Erin McCoy at 410– comments. notice.
786–2337.) 2. By regular mail. You may mail
Information Collection
Dated: June 21, 2017. written comments to the following
William N. Parham, III, address: CMS, Office of Strategic 1. Type of Information Collection
Director, Paperwork Reduction Staff, Office Operations and Regulatory Affairs, Request: Extension of a currently
of Strategic Operations and Regulatory Division of Regulations Development, approved collection; Title of
Affairs. Attention: Document Identifier/OMB Information Collection: State Medicaid
[FR Doc. 2017–13321 Filed 6–23–17; 8:45 am] Control Number _________, Room C4– HIT Plan, Planning Advance Planning
BILLING CODE 4120–01–P 26–05, 7500 Security Boulevard, Document, and Implementation
Baltimore, Maryland 21244–1850. Advance Planning Document for
To obtain copies of a supporting Section 4201 of the Recovery Act; Use:
DEPARTMENT OF HEALTH AND statement and any related forms for the To assess the appropriateness of state
HUMAN SERVICES proposed collection(s) summarized in requests for the administrative Federal
this notice, you may make your request financial participation for expenditures
Centers for Medicare & Medicaid using one of following: under their Medicaid Electronic Health
Services 1. Access CMS’ Web site address at Record Incentive Program related to
https://www.cms.gov/Regulations-and- health information exchange, our staff
[Document Identifier: CMS–10292, CMS–
10332 and CMS–10239] Guidance/Legislation/ will review the submitted information
PaperworkReductionActof1995/PRA- and documentation to make an approval
Agency Information Collection Listing.html. determination of the state advance
Activities: Proposed Collection; 2. Email your request, including your planning document. Form Number:
Comment Request address, phone number, OMB number, CMS–10292 (OMB control number:
and CMS document identifier, to 0938–1088); Frequency: Once and
AGENCY: Centers for Medicare & Paperwork@cms.hhs.gov.
Medicaid Services, HHS. occasionally; Affected Public: State,
3. Call the Reports Clearance Office at Local, and Tribal Governments; Number
ACTION: Notice. (410) 786–1326. of Respondents: 56; Total Annual
FOR FURTHER INFORMATION CONTACT: Responses: 56; Total Annual Hours:
SUMMARY: The Centers for Medicare &
Medicaid Services (CMS) is announcing William Parham at (410) 786–4669. 896. (For policy questions regarding this
an opportunity for the public to SUPPLEMENTARY INFORMATION: collection contact Marty Rice at 410–
comment on CMS’ intention to collect Contents 786–2417.)
information from the public. Under the 2. Type of Information Collection
This notice sets out a summary of the
Paperwork Reduction Act of 1995 (the Request: Extension of a currently
use and burden associated with the
PRA), federal agencies are required to approved collection; Title of
following information collections. More
publish notice in the Federal Register Information Collection: Disclosure
detailed information can be found in
concerning each proposed collection of Requirement for the In-Office Ancillary
each collection’s supporting statement
information (including each proposed Services Exception; Use: Section 6003 of
and associated materials (see
extension or reinstatement of an existing the ACA established a disclosure
ADDRESSES).
collection of information) and to allow requirement for the in-office ancillary
60 days for public comment on the CMS–10292 State Medicaid HIT Plan, services exception to the prohibition of
proposed action. Interested persons are Planning Advance Planning Document, physician self-referral for certain
and Implementation Advance Planning
invited to send comments regarding our Document for Section 4201 of the Recovery
imaging services. This section of the
burden estimates or any other aspect of ACA amended section 1877(b)(2) of the
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Act
this collection of information, including CMS–10332 Disclosure Requirement for the Social Security Act by adding a
the necessity and utility of the proposed In-Office Ancillary Services Exception requirement that the referring physician
information collection for the proper CMS–10239 Conditions of Participation for informs the patient, at the time of the
performance of the agency’s functions, Critical Access Hospitals (CAH) and referral and in writing, that the patient
the accuracy of the estimated burden, Supporting Regulations may receive the imaging service from
ways to enhance the quality, utility, and Under the PRA (44 U.S.C. 3501– another supplier. The implementing
clarity of the information to be 3520), federal agencies must obtain regulations are at 42 CFR 411.355(b)(7).
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Document Created: 2018-11-14 10:10:53
Document Modified: 2018-11-14 10:10:53
| Category | Regulatory Information | |
| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
| Publisher | Office of the Federal Register, National Archives and Records Administration | |
| Section | Notices | |
| Action | Notice. | |
| Dates | Comments on the collection(s) of information must be received by the OMB desk officer by July 26, 2017. | |
| Contact | William Parham at (410) 786-4669. | |
| FR Citation | 82 FR 28851 |
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