[Federal Register Volume 75, Number 74 (Monday, April 19, 2010)]
[Notices]
[Pages 20366-20367]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2010-8901]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-416 and CMS-R-297]
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: Revision of a currently
approved collection; Title of Information Collection: Annual Early and
Periodic Screening, Diagnostic and Treatment (EPSDT) Services
Participation Report; Form Number: CMS-416 (OMB: 0938-0354);
Use: States are required to submit an annual report on the provision of
EPSDT services pursuant to section 1902(a)(43)(D) of the Social
Security Act. These reports provide CMS with data necessary to assess
the effectiveness of State EPSDT programs, to determine a State's
results in achieving its participation goal and to respond to
inquiries. Respondents are State Medicaid Agencies. The data is due
April 1 of every year so States need to have the form and instructions
as soon as possible in order to report timely. Frequency: Yearly;
Affected Public: State, Tribal and Local governments; Number of
Respondents: 56; Total Annual Responses: 112; Total Annual Hours:
1,568. (For policy questions regarding this collection contact Cindy
Ruff at 410-786-5916. For all other issues call 410-786-1326.)
2. 1. Type of Information Collection Request: Extension of a
currently approved collection; Title of Information Collection: Request
for Employment Information; Use: Section 1837(i) of the Social Security
Act provides for a special enrollment period for individuals who delay
enrolling in Medicare Part B because they are covered by a group health
plan based on their own or a spouse's current employment status. When
these individuals apply for Medicare Part B, they must provide proof
that the group health plan coverage is (or was) based on current
employment status. This form is used by the Social Security
Administration to obtain information from employers regarding whether a
Medicare beneficiary's coverage under a group health plan is based on
current employment status. Form Number: CMS-R-297 (OMB: 0938-
0787); Frequency: Once; Affected Public: Private Sector: Business or
other for-profits and Not-for-profit institutions; Number of
Respondents: 5,000; Total Annual Responses: 5,000; Total Annual Hours:
1,250. (For policy questions regarding this collection contact Kevin
[[Page 20367]]
Simpson at 410-786-0017. 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 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.
In commenting on the proposed information collections please
reference the document identifier or OMB control number. To be assured
consideration, comments and recommendations must be submitted in one of
the following ways by June 18, 2010:
1. Electronically. You may submit your comments electronically to
http://www.regulations.gov. Follow the instructions for ``Comment or
Submission'' or ``More Search Options'' to find the information
collection document(s) accepting comments.
2. By regular mail. You may mail written comments to the following
address: CMS, Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development, Attention: Document Identifier/OMB
Control Number, Room C4-26-05, 7500 Security Boulevard, Baltimore,
Maryland 21244-1850.
Dated: April 9, 2010.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. 2010-8901 Filed 4-16-10; 8:45 am]
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