[Federal Register Volume 76, Number 63 (Friday, April 1, 2011)]
[Notices]
[Pages 18222-18223]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-7746]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier CMS-265-11, CMS-381, and CMS-10123 and 10124]
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: Independent Renal
Dialysis Facility Cost Report; Use: The Independent Renal Dialysis
Facility Cost Report, is filed annually by providers participating in
the Medicare program to identify the specific items of cost and
statistics of facility operation that independent renal dialysis
facilities are required to report. The forms are revised in accordance
with the End-Stage Renal Disease Prospective Payment System Final Rule
published August 12, 2010 which implemented statutory requirements of
the Medicare Improvements for Patients and Providers Act (MIPPA),
enacted July 15, 2008. Additionally, the forms are revised to
incorporate data previously reported on the Provider Cost Report
Reimbursement Questionnaire, Form CMS-339. Form Number: CMS-265-94
(OMB: 0938-0236); Frequency: Yearly; Affected Public: Business
or other for-profits and Not-for-profit institutions; Number of
Respondents: 5,654 Total Annual Responses: 5,654; Total Annual Hours:
367,510 (For policy questions regarding this collection contact Gail
Duncan at 410-786-7278. For all other issues call 410-786-1326.)
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Identification of
Extension Units of Medicare Approved Outpatient Physical Therapy/
Outpatient Speech Pathology (OPT/OSP) Providers and Supporting
Regulations in 42 CFR 485.701-485.729; Use: The collected information
is used in conjunction with 42 CFR 485.701 through 485.729 governing
the operation of providers of outpatient physical therapy and speech-
language pathology services. The provider uses the form to report to
the State survey agency extension locations that it has added since the
date of last report. The form is used by the State survey agencies and
by the CMS regional offices to identify and monitor extension locations
to ensure their compliance with the Federal requirements for the
providers of outpatient physical therapy and speech-language pathology
services; Form Number: CMS-381 (OMB : 0938-0273); Frequency:
Annually; Affected Public: Private Sector; Business or other for-profit
and not-for-profit institutions; Number of Respondents: 2,960; Total
Annual Responses: 2,960; Total Annual Hours: 740. (For policy questions
regarding this collection contact Georgia Johnson at 410-786-6859. For
all other issues call 410-786-1326.)
3. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Notice of
Provider Non-Coverage (CMS-10123) and Detailed Explanation of Non-
Coverage (CMS-10124); Use: The Notice of Medicare Provider Non-Coverage
(CMS-10123) is used to inform fee-for-service Medicare beneficiaries of
the determination that their provider services will end, and of their
right to an expedited review of that determination. The Detailed
Explanation of Non-Coverage (CMS-10124) is used to provide
beneficiaries who request an expedited determination with detailed
information of why the services should end. The revised Notice of
Provider Non-Coverage and Detailed Explanation of Provider Non-Coverage
will no longer require use of the beneficiary's Medicare number as a
patient identifier. Instead, when applicable, providers may use a
number that helps to link the notice with a related claim. Form Number:
CMS-10123 and 10124 (OMB 0938-0953); Frequency: Occasionally;
Affected Public: Business or other for-profit, not-for-profit
institutions, and Individuals or households; Number of Respondents:
[[Page 18223]]
5,314,164; Total Annual Responses: 5,314,194; Total Annual Hours:
885,699.
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 at 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 May 31, 2011:
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: March 25, 2011.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. 2011-7746 Filed 3-31-11; 8:45 am]
BILLING CODE 4120-01-P