Information Collection Request (ICR) Tracker

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Federal Register Notices

Authorizing Statutes

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This collection of information is dedicated to Medicare beneficiaries and third party requesters (law firms or others) acting on behalf of beneficiaries that are making requests for CMS to produce Medicare beneficiary records through 5 U.S.C. § 552(b) (See also 42 C.F.R. § 401.136). Currently the requests are mailed / faxed / emailed to CMS. The new online portal will allow for ease and efficiency to upload the request and required authorization, which will be quickly and securely sent directly to CMS.

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Federal Register Notices

Authorizing Statutes

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This Paperwork package provides information regarding the form used by the Medicare, Medicaid, and the Clinical Laboratory Improvement Amendments (CLIA) programs to document a health care facility's compliance or noncompliance (deficiencies) with regard to the Medicare/Medicaid Conditions of Participation and Coverage, the requirements for participation for Skilled Nursing Facilities and Nursing Facilities, and for certification under CLIA. This form becomes the evidentiary basis for CMS certification decisions (including termination or denial of participation), and the form of public disclosure. In December, 2020, Congress passed the Consolidated Appropriations Act, 2021 (CAA, 2021). Section 407 of CAA, 2021, amended Part A of Title XVIII of the Social Security Act (the Act) at section 1822 establishing hospice program survey and enforcement requirements. This amendment, in part, now requires the Accrediting Organizations (AOs) that accredit hospice programs to include the form CMS-2567 to document the findings of their hospice program surveys beginning on October 1, 2021. As of June 2021, there are three AOs with CMS-approved hospice accreditation programs: Accreditation Commission for Health Care, Inc. (ACHC), Community Health Accreditation Partner (CHAP), and The Joint Commission (TJC). These three AOs survey approximately half of the over 5,000 Medicare-certified hospice programs, while the SAs survey the remaining half. To enable AOs to use the form CMS-2567, we must revise it by adding a field for the AO name. Also, the instructions must be updated to include AOs as another group which utilizes the form CMS-2567. We have also included the COI/RIA burden calculations from CMS-1747-P related to the one-time update needed to each AO’s proprietary electronic systems in order to use the form CMS-2567 as directed by the CAA, 2021.

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Authorizing Statutes

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The Centers for Medicare & Medicaid Services (CMS) is requesting the Office of Management and Budget (OMB) approval for the Review Choice Demonstration for Inpatient Rehabilitation Facility (IRF) Services. This demonstration will assist in developing improved procedures for the identification, investigation, and prosecution of potential Medicare fraud. By ensuring that payments for IRF services are appropriate through either pre-claim or postpayment review, this demonstration also works toward the prevention and identification of potential fraud, waste, and abuse, as well as protecting the Medicare Trust Funds from improper payments while reducing Medicare appeals. CMS proposes performing the demonstration in Alabama, Pennsylvania, Texas, and California, as well as IRFs in any state that bill to the Medicare Administrative Contractor (MAC) jurisdictions JJ, JL, JH, and JE.

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The ESRD Network Peer Mentoring Program is voluntary program designed to provide patient peer support to people with kidney disease. In part, the peer support is beneficial because patients can give each other something most practitioners do not have, lived experience with kidney disease. The support and perspective of someone who has “been there” can help people cope better with their circumstances. Peer mentors and mentees will complete an online application form via JIRA/Confluence. Information collection will be stored in an ATO approved location on the HICQS server. The collection includes: First and Last Name, City, State, Email address, Phone Number, best time of day to be contacted, age range (not specific age), length of time range (not specific years) as an ESRD patient, current treatment modality, facility name, city, state, zip code, prefer to be a mentor or mentee, peer gender preference, topics of interest (new to dialysis, ESRD overview, home modalities, transplant), hobbies, skills, vocation, preferred language, internet access, and disposition towards meeting and conversations with new people. The information collected on the ESRD Network Program Peer Mentoring Peer Application will be used solely for the purpose of matching mentors and mentees based on the information collected.

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The Baldrige Performance Excellence Program will seek applicants for the Baldrige Executive Fellows Program, a one-year, leadership development experience for direct reports to the most senior leader in an organization or business unit leaders. Using the Baldrige Excellence Framework as a foundation, the program will discuss impactful leadership through visits to Baldrige Award recipient sites and senior leaders, virtual discussions, and face-to-face peer training using an adult learning model.

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In support an emergent, high-visibility requirement directed in Secretary of Defense Memorandum, “Immediate Actions to Counter Sexual Assault and Harassment and the Establishment of a 90-Day Independent Review Commission on Sexual Assault in the Military,” February 26, 2021. Immediate Action 2 directs the Under Secretary of Defense for Personnel and Readiness (USD(P&R)) to develop a plan of action and milestones to conduct high risk installation evaluations.

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Federal Register Notices

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The conditions for importation of used farm equipment require APHIS to employ the use of a certification statement in which the exporter states that the cleaning has been done.

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Federal Register Notices

Authorizing Statutes

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Health care providers can currently obtain a National Provider Identifier (NPI) via a paper application or over the Internet through the National Plan and Provider Enumeration System (NPPES). These applications must be submitted individually, on a per-provider basis. The Electronic File Interchange (EFI) process allows provider-designated organizations (EFIOs) to capture multiple providers' NPI application information on a single electronic file for submission to NPPES. (This process is also referred to as "bulk enumeration.") To ensure that the EFIO has the authority to act on behalf of each provider and complies with other Federal requirements, an authorized official of the EFIO must sign a certification statement and mail it to the Centers for Medicare and Medicaid Services (CMS).

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Public Law 110-417 mandated the implementation of a centralized, case-level database for the collection, in a manner consistent with Department of Defense regulations for Unrestricted and Restricted Reporting, and maintenance of information regarding sexual assaults involving a member of the Armed Forces, including information, if available, about the nature of the assault, the victim, the offender, and case outcomes in connection with the assault. The law also required the database to be used to develop and implement congressional reports required by law.

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The CMS-724 form is used to collect data that is not collected elsewhere and assists CMS in program planning and evaluation needs and in maintaining an accurate database on providers particiapting in the Medicare psychiatric hospital program.

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Federal Register Notices

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Taxpayers must obtain third-party certification or documentation to avail themselves of certain credits, deductions or other benefits permitted by the Internal Revenue Code. Taxpayers will use these documents or information to support claims for certain credits, deductions or tax benefits on their returns. The Internal Revenue Service may review these documents or information during any examination of taxpayers’ returns to verify the taxpayers’ entitlement to the claimed credits, deductions or tax benefits. This submission contains third-party disclosure regulations subject to the Paperwork Reduction Act of 1995.

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Federal Register Notices

Authorizing Statutes

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The Internal Revenue Code (IRC) at 26 U.S.C. 5704(b) provides that a manufacturer or export warehouse proprietor may, in accordance with regulations prescribed by the Secretary, transfer tobacco products and cigarette papers and tubes, without payment of tax, to the bonded premises of another such entity, or may remove such articles, without payment of tax, for export or consumption beyond the jurisdiction of the internal revenue laws of the United States. In addition, the IRC at 26 U.S.C. 5722 requires that manufacturers of tobacco product and cigarette papers and tubes and export warehouse proprietors make reports as the Secretary may by regulation require. Under those IRC authorities, the TTB regulations in 27 CFR part 44 require manufacturers and export warehouse proprietors to report each such removal to TTB on form TTB F 5200.14, or, under the alternate procedure described in TTB Industry Circular 2004-3, respondents may submit a Monthly Summary Report of such removals provided that the export of each removal is documented by records maintained at the respondent's premises. Respondents also submit letterhead notices to modify certain information on previously-submitted TTB F 5200.1 forms, and they also submit letterhead applications to request TTB authorization to use the alternative Monthly Summary Report procedure. The collected information allows TTB to account for removals of tobacco products and cigarette papers and tubes made without payment of tax and assists in preventing the diversion of such articles to taxable uses. As such, the collected information is necessary to protect the revenue.

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Federal Register Notices

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Lenders provide information required to determne the eligibility of a mortgage to be insured under Section 513 of the Housing and Community Development Act of 1992 (Section 106 of the Energy Policy Act of 1992).

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Federal Register Notices

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The Internal Revenue Code (IRC) at 26 U.S.C. 5706 provides for the drawback (refund) of Federal excise tax paid on tobacco products and cigarette papers and tubes when such articles are subsequently exported from the United States in accordance with the bond and regulatory requirements prescribed by the Secretary. Under that IRC authority, TTB has issued regulations in 27 CFR part 44 governing such drawback claims. Those regulations allow drawback for tax-paid tobacco products and cigarette papers and tubes shipped to a foreign country, Puerto Rico, the Virgin Islands, or a possession of the United States, but only when the person who paid the tax files a claim and otherwise complies with the relevant regulations. Specific to this information collection request, the part 44 regulations require that such drawback claims be filed on form TTB F 5620.7, and that all such claims must be accompanied by a bond filed on form TTB F 5200.17. Under the regulations, claimants also must file evidence with TTB that the articles in question landed at a foreign port or were lost after export. In addition, claimants may file letterhead applications for relief from certain regulatory requirements regarding evidence of export or loss.

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Federal Register Notices

Authorizing Statutes

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To provide consumers with adequate information as to the identity of alcohol beverages and to prevent consumer deception and the use of misleading statements in the marketing of such products, the Federal Alcohol Administration Act at 27 U.S.C. 205(e) requires that alcohol beverages sold or introduced into interstate or foreign commerce be labeled in conformity with regulations issued by the Secretary of the Treasury. Under that authority, the TTB regulations require that, prior to an alcohol beverage product’s introduction into interstate or foreign commerce, the producer, bottler, or importer of the product apply for and receive TTB approval of the product’s label. For wines and distilled spirits, such respondents also may apply for exemption from label approval for products not sold or entered into interstate or foreign commerce. For distilled spirits, the TTB regulations also require approval of distinctive liquor bottles. Respondents use form TTB F 5100.31 or its electronic equivalent, COLAs Online, to request and obtain label approval, exemption from label approval, or approval of a distinctive liquor bottle. The form serves as both an application for and, if approved by TTB, a certificate of label approval (COLA), a certificate of exemption from label approval, or distinctive liquor bottle approval.

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Federal Register Notices

Authorizing Statutes

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The Internal Revenue Code (IRC), at 26 U.S.C. 5114, 5173, 5272, 5354, 5401, and 5711, requires certain alcohol and tobacco industry proprietors to post a collateral or surety bond in conformity with regulations issued by the Secretary of the Treasury to ensure payment of Federal taxes due on alcohol or tobacco products should a proprietor default. When circumstances of an industry member's operation change from those described in an existing surety bond agreement, the TTB regulations authorized under those IRC sections allow the proprietor to complete form TTB F 5000.18, Change in Bond (Consent of Surety), in lieu of obtaining a new bond. Once executed by the proprietor and the surety company, the proprietor files the form with TTB, which retains it as long as the revised bond agreement remains in force.

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In addition, regulations at 42 CFR 413.20 and 413.24 require adequate cost data and cost reports from providers on an annual basis. The Form CMS-2088-17 cost report is needed to determine a provider’s reasonable costs incurred in furnishing medical services to Medicare beneficiaries and reimbursement due to or due from a provider.

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The EPA’s Office of Air and Radiation (OAR) developed the SmartWay Transport Partnership (“SmartWay”) under directives outlined in Subtitle D of the Energy Policy Act of 2005 which calls on EPA to assess the energy and air quality impacts of activities within the freight industry. These activities include long-duration truck idling, the development and promotion of strategies for reducing idling, fuel consumption, and negative air quality effects. SmartWay’s objectives also are consistent with the Federal Technology Transfer Act and other laws that support collaborative partnerships between government and industry. SmartWay is open to organizations that own, operate, or contract with fleet operations, including truck and multi-modal carriers, air carriers, logistics companies, and shippers. Organizations that do not operate fleets, but that are working to strengthen the freight industry, such as industry trade associations, state and local transportation agencies and environmental groups, also may join as SmartWay Affiliates. All organizations that join SmartWay are asked to provide EPA with information as part of their SmartWay registration to annually benchmark their transportation-related operations and improve the environmental performance of their freight activities. A company joins SmartWay when it completes and submits a SmartWay Excel-based Partnership tool (“reporting tool”) to EPA. The data outputs from the submitted tool are used by Partners and SmartWay in several ways. First, the data provides confirmation that SmartWay Partners are meeting established objectives as in their Partnership Agreement. The reporting tool outputs enable EPA to assist SmartWay Partners in adjusting their commitments, as appropriate, and to update them with environmental performance and technology information that empower them to improve their efficiency. This information also improves EPA’s knowledge and understanding of the environmental and energy impacts associated with goods movement, and the effectiveness of both proven and emerging strategies to lessen those impacts. In addition to requesting annual transportation-related data, EPA may ask its SmartWay Partners for other kinds of information which could include opinions and test data on the effectiveness of new and emerging technology applications, sales volumes associated with SmartWay-recommended vehicle equipment and technologies, the reach and value of partnering with EPA through the SmartWay Partnership, and awareness of the SmartWay brand. In some instances, EPA might query other freight industry representatives (not just SmartWay Partners), including trade and professional associations, nonprofit environmental groups, energy, and community organizations, and universities, and a small sampling of the general public.

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The owners and operators of municipal solid waste landfills are required to comply with reporting and record keeping requirements for the General Provisions (40 CFR Part 60,Subpart A), as well as for the requirements of 40 CFR Part 60 Subpart XXX. This includes submitting initial notifications, performance tests and periodic reports and results, and maintaining records of the occurrence and duration of any startup, shutdown, or malfunction in the operation of an affected facility, or for any period during which the monitoring system is inoperative. These reports are used by EPA to determine compliance with these standards.

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Federal Register Notices

Authorizing Statutes

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This information collection is needed to evaluate the adequacy of reception facilities prior to issuance of a Certificate of Adequacy. Information for the advance notice ensures effective management of reception facilities and reduces the burden to facilities and ships. Respondents are reception facilities and vessels. The statutory authority is 33 U.S. Code 1903 and 1905.