[Federal Register Volume 77, Number 124 (Wednesday, June 27, 2012)]
[Notices]
[Pages 38297-38298]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-15694]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier CMS-359 and -360]
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:
Comprehensive Outpatient Rehabilitation Facility (CORF) Eligibility and
Survey Forms. Use: CMS-359 serves as the application for facilities
wishing to participate in the Medicare/Medicaid program as CORFs. The
form initiates the process for obtaining a decision as to whether the
conditions of participation are met. It also promotes data reduction
(key punching) or introduction to and retrieval from the Medicare/
Medicaid Automated Certification System, ASPEN, by the CMS Regional
Offices (ROs). Should any question arise regarding the structure of the
organization, this information is readily available without going
through the process of completing the form again.
CMS-360 is used by the State survey agency to record data collected
to determine provider compliance with individual conditions of
participation and to report it to the Federal government. CMS has the
responsibility and authority for certification decisions which are
based on provider compliance with the conditions of participation. The
information needed to make these decisions is available to CMS only
through use of information abstracted from the survey checklists. The
form is primarily a worksheet designed to facilitate keypunching into
the ASPEN by the State Agency after the survey is completed.
Form Number: CMS-359 (CORF Eligibility Form) and CMS-360 (CORF
Survey Report Form); OCN 0938-0267. Frequency: Occasionally. Affected
Public: Private Sector (Business or other for-profits). Number of
Respondents: 295. Total Annual Responses: 42. Total Annual Hours: 137.
(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 Email 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
[[Page 38298]]
be submitted in one of the following ways by August 27, 2012:
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: June 22, 2012.
Martique Jones,
Director, Regulations Development Group, Division B, Office of
Strategic Operations and Regulatory Affairs.
[FR Doc. 2012-15694 Filed 6-26-12; 8:45 am]
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