[Federal Register Volume 76, Number 14 (Friday, January 21, 2011)]
[Notices]
[Pages 3909-3910]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2011-1265]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-R-148, CMS-R-266, and CMS-216]


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: Extension without change 
of a currently approved collection; Title of Information Collection: 
Limitations on Provider Related Donations and Health Care Related 
Taxes; Limitation on Payments for Disproportionate Share Hospitals and 
Supporting Regulations in 42 CFR 433.68, 433.74 and 447.272; Use: This 
information collection is necessary to ensure compliance with Sections 
1903 and 1923 of the Social Security Act for the purpose of preventing 
payments of Federal financial participation on amounts prohibited by 
statute; Form Number: CMS-R-148 (OMB: 0938-0618); Frequency: 
Quarterly and occasionally; Affected Public: State, Local, or Tribal 
Governments; Number of Respondents: 50; Total Annual Responses: 40; 
Total Annual Hours: 3,200. (For policy questions regarding this 
collection

[[Page 3910]]

contact Rory Howe at 410-786-4878. For all other issues call 410-786-
1326.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicaid 
Disproportionate Share Hospital Annual Reporting; Use: Section 
1923(j)(i) of the Social Security Act requires States to submit an 
annual report that identifies each disproportionate share hospital 
(DSH) that received a DSH payment under the State's Medicaid program in 
the preceding fiscal year and the amount of DSH payments paid to that 
hospital in the same year and such other information as the Secretary 
determines necessary to ensure the appropriateness of DSH payments. The 
information supplied will also satisfy the requirements under section 
1923(a)(2)(D) of the Act; Form Number: CMS-R-266 (OMB: 0938-
0746); Frequency: Yearly; Affected Public: State, Local, or Tribal 
Governments; Number of Respondents: 52; Total Annual Responses: 52; 
Total Annual Hours: 1,976. (For policy questions regarding this 
collection contact Rory Howe at 410-786-4878. For all other issues call 
410-786-1326.)
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Organ Procurement 
Organization/Histocompatibility Laboratory Statement of Reimbursable 
Costs, manual instructions and supporting regulations contained in 42 
CFR 413.20 and 413.24; Use: This form is required by the statute and 
regulation for participation in the Medicare program. The information 
is used to determine payment for Medicare. Organ Procurement 
Organizations and Histocompatibility Laboratories are the users. Form 
Number: CMS-216-94 (OMB 0938-0102); Frequency: Yearly; 
Affected Public: Business or other for-profit, not-for-profit 
institutions; Number of Respondents: 115; Total Annual Responses: 115; 
Total Annual Hours: 5,175.
    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 Paperwork@cms.hhs.gov, 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 March 22, 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.

Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2011-1265 Filed 1-20-11; 8:45 am]
BILLING CODE 4120-01-P