[Federal Register Volume 77, Number 25 (Tuesday, February 7, 2012)]
[Page 6125]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-2762]



Centers for Medicare & Medicaid Services

[Document Identifier: CMS-29 and CMS-10366]

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: Revision of a currently 
approved collection; Title of Information Collection: Request for 
Certification as a Rural Health Clinic Form and Supporting Regulations 
in 42 CFR 491.1-491.11; Use: The Form CMS-29, Request for Certification 
as a Supplier of Rural Health Clinic (RHC) Services under the Medicare/
Medicaid Program, is utilized as an application to be completed by 
suppliers of RHC services requesting participation in the Medicare 
program. This form initiates the process of obtaining a decision as to 
whether the conditions for certification are met as a supplier of RHC 
services. It also promotes data reduction or introduction to and 
retrieval from the Automated Survey Process Environment (ASPEN) and 
related survey and certification databases by the CMS Regional Offices. 
Should any question arise regarding the structure of the organization, 
this information is readily available. With this renewal request, the 
title of the Form CMS-29 is being revised to better describe the 
purpose of the data being collected. Both new and existing clinics must 
provide and attest to the accuracy of specific clinic data as a part of 
the RHC certification process. Therefore, the revised title is ``Form 
CMS-29/Verification of Clinic Data--Rural Health Clinic Program.'' The 
Form CMS-29 is also being revised to remove Section V, Federal Support. 
The information captured under Section V is not a deciding factor as to 
whether or not a clinic meets RHC certification requirements. 
Therefore, it is unnecessary to require facilities to complete this 
section as a part of the certification process; Form Number: CMS-29 
(OCN 0938-0074); Frequency: Occasionally (initially and then every six 
years); Affected Public: Private Sector (Business or other for-profit 
and Not-for-profit institutions); Number of Respondents: 3,981; Total 
Annual Responses: 830; Total Annual Hours: 138. (For policy questions 
regarding this collection contact Shont[eacute] Carter at (410) 786-
3532. For all other issues call (410) 786-1326.)
    2. Type of Information Collection Request: New collection (request 
for new OMB control number); Title of Information Collection: Nursing 
Home Quality Improvement Questionnaire; Use: The information obtained 
via the Nursing Home Quality Improvement Questionnaire will be utilized 
by CMS staff in the Survey & Certification Group, Division of Nursing 
Homes, to identify areas for quality assurance and performance 
improvement (QAPI) technical assistance (TA) that will be useful to 
nursing facilities as they prepare to meet the new QAPI regulation that 
was mandated as part of the Affordable Care Act. Specifically, the 
information collected through the use of the questionnaire will be used 
to establish a baseline of QAPI practices in nursing homes, gather 
information on the challenges and barriers to implementing effective 
QAPI programs, assess the development of QAPI systems, determine what 
types of TA to make available to nursing homes, and assess the 
potential impact of TA in advancing QAPI in nursing homes; Form Number: 
CMS-10366 (OCN 0938-New); Frequency: Once; Affected Public: Private 
Sector (Business or other for-profits and Not-for-profit institutions) 
and State, Local or Tribal Governments; Number of Respondents: 4,200; 
Total Annual Responses: 4,200; Total Annual Hours: 1,386. (For policy 
questions regarding this collection contact Debra Lyons at (410) 786-
6780. 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 Paperwork@cms.hhs.gov, 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 March 8, 2012. 
OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk 
Officer. Fax Number: (202) 395-6974. Email: OIRA_submission@omb.eop.gov.

    Dated: January 31, 2012.
Martique Jones,
Director, Regulations Development Group, Division-B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2012-2762 Filed 2-6-12; 8:45 am]