[Federal Register: December 19, 2003 (Volume 68, Number 244)]
[Notices]
[Page 70800-70801]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr19de03-67]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare and Medicaid Services
[Document Identifier: CMS-437, 437A, 437B; CMS-255; CMS-R-199; CMS-
10086]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
Agency: Centers for Medicare and Medicaid Services.
In compliance with the requirement of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the Centers for Medicare and Medicaid
Services (CMS) (formerly known as the Health Care Financing
Administration (HCFA), Department of Health and Human Services, is
publishing the following summary of proposed collections for public
comment. Interested persons are invited to send comments regarding this
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 technology to minimize the information
collection burden.
1. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Psychiatric Unit
Criteria Worksheet, Rehabilitation Unit Criteria Worksheet, and
Rehabilitation Hospital Criteria Worksheet, and Supporting Regulations
at 42 CFR 488.26; Form No.: CMS-437, 437A, and 437B (OMB 0938-
0358); Use: The rehabilitation hospital/unit and psychiatric unit
criteria worksheets are necessary to verify and reverify that these
facilities/units comply and remain in compliance with the exclusion
criteria for the Medicare prospective payment system; Frequency:
Annually; Affected Public: Business or other-for-profit, not-for-profit
institutions; Number of Respondents: 2,610; Total Annual Responses:
2,610; Total Annual Hours: 653.
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Municipal Health
Services Cost Report Form and supporting Regulations 42 CFR 405.2470;
Form No.: CMS-255 (OMB 0938-0155); Use: The Municipal Health
Services Program Cost Report (CMS 255) is used by the participating
clinics to report costs for health care services rendered to Medicare
beneficiaries. It is also used to gather data to properly evaluate the
demonstration; Frequency: Annually; Affected Public: Not-for-profit
institutions; Number of Respondents: 14; Total Annual Responses: 14;
Total Annual Hours: 476.
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicaid Report
on Payables and Receivables; Form No.: CMS-R-199 (OMB 0938-
0697); Use: The Chief Financial Officers Act of 1990 requires
government agencies to produce auditable financial statements. This
form will collect accounting data from the States on Payables and
Receivables; Frequency: Annually; Affected Public: State, local or
tribal government; Number of Respondents: 57; Total Annual Responses:
57; Total Annual Hours: 342.
4. Type of Information Request: Extension of a currently approved
collection; Type of Information Collection: Medicaid Program: Real
Choice Systems Change Grants for Community Living; CMS Form Number:
CMS-10086 (OMB 0938-0901); Use: Executive Order 13217,
``Community-Based Alternatives for Individuals with Disabilities''
called upon the Federal government to assist States and localities to
swiftly implement the decision of the United States Supreme Court in
Olmstead v. L.C., stating: ``The United States is committed to
community-based alternatives for individuals with disabilities and
recognizes that such services advance the best interests of the United
States.'' State agencies and community groups will be applying for
these grants; Frequency: On occasion; Affected Public: State, local, or
tribal government; not-for-profit institutions; Number of Respondents:
75; Total Annual Responses: 150; Total Annual Burden Hours: 1500.
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, access CMS Web
site address at http://cms.hhs.gov/regulations/pra/default.asp, or E-
mail your request, including your address, phone number, OMB number,
and CMS document identifier, to Paperwork@hcfa.gov, or call the Reports
Clearance Office on (410) 786-1326. Written comments and
recommendations for the proposed information collections must be mailed
within 30 days of this notice directly to the OMB desk officer: OMB
Human Resources and Housing Branch, Attention: Brenda Aguilar, New
Executive Office Building, Room 10235, Washington, DC 20503.
[[Page 70801]]
Dated: December 12, 2003.
Julie Brown,
Acting, Paperwork Reduction Act Team Leader, CMS Reports Clearance
Officer, Office of Strategic Operations and Strategic Affairs, Division
of Regulations Development and Issuances.
[FR Doc. 03-31357 Filed 12-18-03; 8:45 am]
BILLING CODE 4120-03-P