[Federal Register Volume 77, Number 142 (Tuesday, July 24, 2012)]
[Notices]
[Pages 43288-43289]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-17924]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10389, CMS-855S and CMS-855(A,B,I,R)]
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: New collection (request
for a new OMB control number). Title of Information Collection: The
Home and Community-Based Service (HCBS) Experience Survey. Use: This
study is a one-time pilot field test involving individuals who receive
HCBS from Medicaid programs. The field test will be conducted for the
following purposes: (a) To assess survey methodology--to determine how
well a face-to-face survey and telephone survey performs with
individuals who receive HCBS services; (b) Psychometric Analysis--to
provide information for the revision and shortening of the survey based
on the assessment of the reliability and construct validity of survey
items and composites; and (c) Case mix adjustment analysis--to assess
the variables that may be considered as case mix adjusters. These
preliminary research activities are not required by regulation, and
will not be used by CMS to regulate or sanction its customers. They
will be entirely voluntary and the confidentiality of respondents and
their responses will be preserved.
The information collected will be used to revise and test the
survey instrument described in the Background section of the PRA
package's Supporting Statement. Within the PRA package, Attachment B
includes two versions of the survey (one modified for accessibility)
and Attachment C has the introductory information. The end result will
be an improvement in information collection instruments and in the
quality of data collected, a reduction or minimization of respondent
burden, increased agency efficiency, and improved responsiveness to the
public. Following the field test, CMS will seek approval from the CAHPS
consortium for the HCBS Experience Survey to be a new addition to the
CAHPS[supreg] family of surveys. Form Number: CMS-10389 (OCN 0938-New).
Frequency: Once. Affected Public: Individuals and Households. Number of
Respondents: 18,000. Total Annual Responses: 18,000. Total Annual
Hours: 9,000. (For policy questions regarding this collection contact
Anita Yuskauskas at 410-786-0268. For all other issues call 410-786-
1326.)
2. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Medicare
Enrollment Application--Durable Medical Equipment, Prosthetics,
Orthotics and Supplies (DMEPOS) Suppliers Use: The primary function of
the CMS 855S Durable Medical Equipment, Prosthetics, Orthotics and
Supplies (DMEPOS) supplier enrollment application is to gather
information from a supplier that tells us who it is, whether it meets
certain qualifications to be a health care supplier, where it renders
its services or supplies, the identity of the owners of the enrolling
entity, and information necessary to establish the correct claims
payment. The goal of evaluating and revising the CMS 855S DMEPOS
supplier enrollment application is to simplify and clarify the
information collection without jeopardizing our need to collect
specific information. The majority of the revisions contained in this
submission are non-substantive in nature such as spelling and
formatting corrections; however, we also removed duplicate fields and
obsolete questions and provided clarification and simplified the
instructions for the completing the application. Form Number: CMS-
855(S) (OCN: 0938-1056); Frequency: Yearly; Affected Public: Private
Sector; Business or other for-profit and not-for-profit institutions;
Number of Respondents: 43,350; Total Annual Responses: 43,350; Total
Annual Hours: 113,550 (For policy questions regarding this contact Kim
McPhillips at 410-786-5374. For all other issues call 410-786-1326.)
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare
Enrollment Application Use: The primary function of the CMS-855
Medicare enrollment application is to gather information from a
provider or supplier that tells us who it is, whether it meets certain
qualifications to be a health care provider or supplier, where it
practices or renders its services, the identity of the owners of the
enrolling entity, and other information necessary to establish correct
claims payments. Form Number: CMS-855(A, B, I, R) (OCN: 0938-0685);
Frequency: Yearly; Affected Public: Private Sector; Business or other
for-profit and not-for-profit institutions; Number of Respondents:
440,450; Total Annual Responses: 440,450; Total Annual Hours: 856,395
(For policy questions regarding this
[[Page 43289]]
contact Kim McPhillips at 410-786-5374. 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.
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 August 23, 2012.
OMB, Office of Information and Regulatory Affairs,
Attention: CMS Desk Officer,
Fax Number: (202) 395-6974,
Email: [email protected].
Dated: July 18, 2012.
Martique Jones,
Director, Regulations Development Group, Division B, Office of
Strategic Operations and Regulatory Affairs.
[FR Doc. 2012-17924 Filed 7-23-12; 8:45 am]
BILLING CODE 4120-01-P