[Federal Register Volume 75, Number 242 (Friday, December 17, 2010)]
[Notices]
[Pages 78999-79000]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-31599]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-18F5 and CMS-R-26]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
AGENCY: Centers for Medicare & Medicaid Services, HHS.
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: Application for
Hospital Insurance; Use: Individuals who are not entitled to or
eligible for railroad retirement board (RRB) or Social Security
Administration benefits must file an application for Part A. This group
includes individuals who defer filing an application for monthly
benefits, individuals who are transitionally insured, government
employees who pay only the Hospital Insurance portion of the Federal
Insurance Contributions Act tax and individuals eligible for Premium
Part A for the Working Disabled. The Application for Hospital
Insurance-CMS-18F5 was designed to capture all the information needed
to make a determination of an individual's
[[Page 79000]]
entitlement to Part A and Supplementary Medical Insurance (Part B).
Form Number: CMS-18F5 (OMB: 0938-0251); Frequency: Once;
Affected Public: Individuals or households; Number of Respondents:
50,000; Total Annual Responses: 50,000; Total Annual Hours: 12,495.
(For policy questions regarding this collection contact Naomi Rappaport
at 410-786-2175. For all other issues call 410-786-1326.)
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Clinical
Laboratory Improvement Amendment (CLIA) of 1988 and Supporting
Regulations in 42 CFR 493.1-.2001; Use: The information collection
requirements in 42 CFR part 493 outline the requirements necessary to
determine an entity's compliance with CLIA. CLIA requires laboratories
that perform testing on human beings to meet performance requirements
(quality standards) in order to be certified by the Department of
Health and Human Services (DHHS). DHHS conducts inspections to
determine a laboratory's compliance with CLIA requirements. CLIA
implements the certificate, laboratory standards and inspection
requirements; Form Number: CMS-R-26 (OMB: 0938-0612);
Frequency: Occasionally; Affected Public: Federal Government; State,
Local, or Tribal Governments; Private Sector: Business or other for-
profits and not-for-profit institutions; Number of Respondents:
168,688; Total Annual Responses: 756,240; Total Annual Hours:
11,363,280. (For policy questions regarding this collection contact
Raelene Perfetto at 410-786-6876. 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 [email protected], 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 January 18, 2011.
OMB, Office of Information and Regulatory Affairs, Attention: CMS
Desk Officer, Fax Number: (202) 395-6974. E-mail: [email protected].
Dated: December 10, 2010.
Martique Jones,
Director, Regulations Development Division-B, Office of Strategic
Operations and Regulatory Affairs.
[FR Doc. 2010-31599 Filed 12-16-10; 8:45 am]
BILLING CODE 4120-01-P