[Federal Register: May 29, 2009 (Volume 74, Number 102)]
[Notices]
[Page 25754]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr29my09-72]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-643 and CMS-359/360]
Agency Information Collection Activities: Submission for OMB
Review; 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), 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 function; (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: Hospice Survey
and Deficiencies Report; Use: In order to participate in the Medicare
program, a hospice must meet certain Federal health and safety
conditions of participation. This form is used by State surveyors to
record data about a hospice's compliance with these conditions of
participation in order to initiate the certification or recertification
process. Form Number: CMS-643 (OMB: 0938-0379); Frequency:
Reporting--Yearly; Affected Public: State, Local or Tribal Governments;
Number of Respondents: 3377; Total Annual Responses: 1130; Total Annual
Hours: 1130. (For policy questions regarding this collection contact
Kim Roche at 410-786-3524. For all other issues call 410-786-1326.)
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Comprehensive
Outpatient Rehabilitation Facility (CORF) Eligibility and Survey Forms
and Information Collection Requirements at 42 CFR 485.54 through
485.66; Use: In order to participate in the Medicare program as a CORF,
providers must meet Federal conditions of participation. The
certification form is needed to determine if providers meet at least
preliminary requirements. The survey form is used to record provider
compliance with the individual conditions and report findings to CMS.
Form Number: CMS-359/360/R-55 (OMB: 0938-0267); Frequency:
Reporting--Occasionally; Affected Public: Private Sector: Business or
other for-profits; Number of Respondents: 476; Total Annual Responses:
60; Total Annual Hours: 223,285. (For policy questions regarding this
collection contact Georgia Johnson at 410-786-6859. For all other
issues call 410-786-1326.)
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/PaperworkReductionActof1995, 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.
To be assured consideration, comments and recommendations for the
proposed information collections must be received by the OMB desk
officer at the address below, no later than 5 p.m. on June 29, 2009.
OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk
Officer, Fax Number: (202) 395-6974, E-mail: OIRA_
submission@omb.eop.gov.
Dated: May 21, 2009.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. E9-12529 Filed 5-28-09; 8:45 am]
BILLING CODE 4120-01-P