[Federal Register Volume 76, Number 117 (Friday, June 17, 2011)]
[Notices]
[Pages 35444-35445]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-15057]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier CMS-1856 and CMS-1893]
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: (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-language
pathology services requesting participation in the Medicare and
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
[[Page 35445]]
speech-language pathology services. It is used by the State agencies to
enter new provider into the Automated Survey Process Environment
(ASPEN). 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 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 July 18, 2011:
OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk
Officer, Fax Number: (202) 395-6974, E-mail: [email protected].
Dated: June 14, 2011.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. 2011-15057 Filed 6-16-11; 8:45 am]
BILLING CODE 4120-01-P