[Federal Register: April 25, 2005 (Volume 70, Number 78)]
[Notices]
[Page 21199-21200]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr25ap05-42]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-1856 & 1893, CMS-R-273]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare & Medicaid Services.
In compliance with the requirement of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the Centers for Medicare & Medicaid
Services (CMS) 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: Request for
Certification in the Medicare and/or Medicaid Program to Provide
Outpatient Physical Therapy (OPT) and/or Speech Pathology Services, OPT
Speech Pathology Survey Report and Supporting Regulations in 42 CFR
485.701-485.729.; Form No.: CMS-1856, CMS-1893 (OMB 0938-
0065); Use: The Medicare Program requires OPT providers to meet certain
health and safety requirements. The request for certification form is
used by State agency surveyors to determine if minimum Medicare
eligibility requirements are met. The survey report form records the
result of the on-site survey; Frequency: On occasion and Other--every 6
years; Affected Public: Business or other for-profit; Number of
[[Page 21200]]
Respondents: 2,968; Total Annual Responses: 495; Total Annual Hours:
866.
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Community Mental
Health Center Site Visit Assessment Tool and Supporting Regulations in
42 CFR 410.2; Form No.: CMS-R-273 (OMB 0938-0770); Use: This
collection instrument aids CMS in its efforts to ensure that new and
existing Community Mental Health Centers (CMHC) are compliant with
Medicare provider requirements, and all applicable Federal and State
requirements. The collection pertains to CMHC's provision of pre-
admission screening to State mental health facilities and to expanding
the collection tool's use into other program areas as a means to screen
applicants, enrollees, and existing providers/suppliers to ensure their
legitimacy to participate in the Medicare Program; Frequency:
Reporting-Other, upon initial application or re-enrollment into the
Medicare program; Affected Public: Business or other for-profit, Not-
for-profit institutions, and State, local or tribal government; Number
of Respondents: 4,731; Total Annual Responses: 4,731; Total Annual
Hours: 20,372.
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://www.cms.hhs.gov/regulations/pra/, or e-mail
your request, including your address, phone number, OMB number, and CMS
document identifier, to Paperwork@cms.hhs.gov, or call the Reports
Clearance Office on (410) 786-1326.
Written comments and recommendations for the proposed information
collections must be mailed within 60 days of this notice directly to
the CMS Paperwork Reduction Act Reports Clearance Office designated at
the address below: CMS, Office of Strategic Operations and Regulatory
Affairs, Division of Regulations Development, Attention: Melissa
Musotto, PRA Analyst, Room C4-26-05, 7500 Security Boulevard,
Baltimore, Maryland 21244-1850.
Dated: April 15, 2005.
Michelle Shortt,
Acting Director, Regulations Development Group, Office of Strategic
Operations and Regulatory Affairs.
[FR Doc. 05-8163 Filed 4-22-05; 8:45 am]
BILLING CODE 4120-01-P