[Federal Register: March 18, 2002 (Volume 67, Number 52)]
[Notices]
[Page 12019-12020]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr18mr02-78]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Center for Medicare and Medicaid Services
[CMS-R-211]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
AGENCY: Center for Medicare and Medicaid Services, HHS.
In compliance with the requirement of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the Center for Medicare and Medicaid
Services (CMS) (formerly known as the Health Care Financing
Administration (HCFA), 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 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.
Type of Information Collection Request: Revision of a currently
approved collection.
Title of Information Collection: Model Application Template for
State Child Health Plan Under Title XXI of the Social Security Act,
State Children's Health Insurance Program, and Model Application
Template and Instructions.
Form No.: CMS-R-211 (OMB# 0938-0707).
Use: States are required to submit Title XXI plans and amendments
for approval by the Secretary pursuant to
[[Page 12020]]
section 2102 of the Social Security Act in order to receive funds for
initiating and expanding health insurance coverage for uninsured
children. The Model Application Template is used to assist States in
submitting a State Child Health Plan and amendments to that plan.
Frequency: Once.
Affected Public: State, local, or tribal gov't.
Number of Respondents: 42.
Total Annual Responses: 42.
Total Annual Hours: 3,360.
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.hcfa.gov/regs/prdact95.htm, or e-mail
your request, including your address, phone number, OMB number, and CMS
document identifier, to Paperwork@hcfa.gov, or call the Reports
Clearance Office on (410) 786-1326. Written comments and
recommendations for the proposed information collections must be mailed
within 30 days of this notice directly to the OMB desk officer: OMB
Human Resources and Housing Branch, Attention: Brenda Aguilar, New
Executive Office Building, Room 10235, Washington, DC 20503.
Dated: February 21, 2002.
John P. Burke III,
CMS Reports Clearance Officer, CMS Office of Information Services,
Security and Standards Group, Division of CMS Enterprise Standards.
[FR Doc. 02-6348 Filed 3-15-02; 8:45 am]
BILLING CODE 4120-03-P