[Federal Register Volume 76, Number 68 (Friday, April 8, 2011)]
[Notices]
[Pages 19776-19777]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-8462]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10252, CMS-1856 and CMS-1893]
Agency Information Collection Activities: Proposed Collection;
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) 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: Certificate of
Destruction for Data Acquired from the Centers for Medicare and
Medicaid Services; Use: The Certificate of Destruction is used by
recipients of CMS data to certify that they have destroyed the data
they have received through a CMS Data Use Agreement (DUA). The DUA
requires the destruction of the data at the completion of the project/
expiration of the DUA. The DUA addresses the conditions under which CMS
will disclose and the User will maintain CMS data that are protected by
the Privacy Act of 1974, Sec. 552a and the Health Insurance
Portability Accountability Act of 1996. CMS has developed policies and
procedures for such disclosures that are based on the Privacy Act and
the Health Insurance Portability Act (HIPAA). The Certificate of
Destruction is required to close out the DUA and to ensure the data are
destroyed and not used for another purpose. Form Number: CMS-10252
(OMB 0938-1046); Frequency: On occasion; Affected Public:
Business or other for-profit; Number of Respondents: 500; Total Annual
Responses: 500; Total Annual Hours: 84. (For policy questions regarding
this collection, contact Sharon Kavanagh at (410) 786-5441. For all
other issues call (410) 786-1326.)
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: (CMS-1856)
Request for Certification in the Medicare and/or Medicaid Program to
Provide Outpatient Physical Therapy and/or Speech Pathology Services,
and (CMS-1893) Outpatient Physical Therapy--Speech Pathology Survey
Report; Use: CMS-1856 is used as an application to be completed by
providers of outpatient physical therapy and/or speech-
[[Page 19777]]
language pathology services requesting participation in Medicare/
Medicaid programs. This form initiates the process for obtaining a
decision as to whether the conditions of participation are met as a
provider of outpatient physical therapy and/or speech-language
pathology services. It is used by the State agencies to enter new
provider into the ASPEN (Automated Survey Process Environment). CMS-
1893 is used by the State survey agency to record data collected during
an on-site survey of a provider of outpatient physical therapy and/or
speech-language pathology services, to determine compliance with the
applicable conditions of participation, and to report this information
to the Federal Government. The form is primarily a coding worksheet
designed to facilitate data reduction and retrieval into the ASPEN
system. The information needed to make certification decisions is
available to CMS only through the use of information abstracted from
the form; Form Numbers: CMS-1856 and CMS-1893 (OMB: 0938-
0065); Frequency: Annually, occasionally; Affected Public: Private
Sector; Business or other for-profit and not-for-profit institutions;
Number of Respondents: 2,968; Total Annual Responses: 495; Total Annual
Hours: 866. (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 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 June 7, 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: April 1, 2011.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. 2011-8462 Filed 4-7-11; 8:45 am]
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