Change Requests

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Medicare Enrollment Application for Physician and Non-Physician Practitioners (CMS-855I)

Key Information

Abstract

The primary function of the CMS-855I Medicare enrollment application for physicians and non-physician practitioners is to gather information from an individual provider or supplier that tells us who he/she is, whether he/she meets certain qualifications to be a Medicare health care provider or supplier, where he/she practices or renders services, and other information necessary to establish correct claims payments.

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

42 USC 424.500	View Law

Pub.L. 109 - 220 508	View Law

42 USC 424.502	View Law

31 USC 7701(c)	View Law

5 USC 522(b)(4)	View Law

26 USC 501(c)	View Law

26 USC 3402(t)	View Law

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Medicare Quality of Care Complaint Form (CMS-10287)

Key Information

Abstract

In accordance with Section 1154(a)(14) of the Social Security Act, QIOs are required to conduct appropriate reviews of all written complaints submitted by beneficiaries concerning the quality of care received. This form will establish a standard form for all beneficiaries to utilize and ensure pertinent information is obtained by QIOs to effectively process these complaints.

SPD-15 Implementation	Yes

Federal Register Notices

60-Day FRN	View Notice
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Authorizing Statutes

42 USC 1395c-3(a)(14)	View Law

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Supporting Statement for Agent/Broker Consent Information Collection (CMS-10840)

Key Information

Abstract

The Patient Protection and Affordable Care Act, Public Law 111-148, enacted on March 23, 2010, and the Health Care and Education Reconciliation Act, Public Law 111-152, enacted on March 30, 2010 (collectively, “Affordable Care Act”), expanded access to health insurance for individuals and employees of small businesses through the establishment of new Affordable Insurance Exchanges (Exchanges), also called Marketplaces. The Exchanges, which became operational on January 1, 2014, enhance competition in the health insurance market, expand access to affordable health insurance for millions of Americans, and provide consumers with a place to easily compare and shop for health insurance coverage. Section 1312(e) of the Affordable Care Act directs the Secretary of the Department of Health and Human Services (HHS) to establish procedures under which a state may permit agents and brokers to enroll qualified individuals and employers into qualified health plans (QHPs) offered through an Exchange and to enable these agents and brokers to assist individuals in applying for advance payments of the premium tax credit and cost-sharing reductions. Authority for collection of this information comes from 45 C.F.R. §155.220(c)(5), which states that “HHS or its designee may periodically monitor and audit an agent, broker, or web-broker under this subpart to assess its compliance with the applicable requirements of this section.” This information collection specifically details what information will be required to be collected and maintained by agents, brokers, and web-brokers were they to receive a request from HHS for consent records. Currently, HHS only plans to collect information from a small percentage of agents, brokers, or web-brokers in conjunction with active investigations of potential fraud. Utilizing §155.220(c)(5) and the information to be collected under newly proposed §§ 155.220(j)(2)(ii)(A)(1-2) and 155.220(j)(2)(iii)(A-C), HHS will be able to verify whether or not an agent, broker, or web-broker has obtained consent from a consumer they are assisting in enrolling in coverage in the individual market, and whether the consumer has reviewed their eligibility information and confirmed its accuracy.

Federal Register Notices

60-Day FRN	View Notice

Authorizing Statutes

45 USC 155.220	View Law

Pub.L. 111 - 148 1312	View Law

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Data Request and Attestation for PDP Sponsors (CMS-10691)

Key Information

Abstract

42 CFR 423.513(g)(1)(i) states that beginning in plan year 2020, a PDP sponsor may submit a request to CMS for the data described in paragraph (g)(2) about enrollees in its prescription drug plans. In addition, paragraph (g)(5) provides that as a condition of receiving the requested data, the PDP sponsor must attest that it will adhere to the permitted uses and limitations on the use of the Medicare claims data listed in paragraphs (g)(3) and (4).

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

Pub.L. 115 - 123 50354	View Law

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Financial Report Form ETA-9130

Key Information

Abstract

ETA utilizes the e-Grants Federal Reporting System, an online 9130 reporting system for recipients to enter and certify quarterly financial data. The data collected is used to assess the effectiveness of ETA programs and to monitor and analyze the financial activity of its recipients. This data collection format permits ETA to evaluate program effectiveness, monitor compliance with statutory limitations, and analyze financial activity, while complying with OMB efforts to streamline Federal financial reporting.

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

29 USC 3245	View Law

Pub.L. 106 - 107 8	View Law

29 USC 3244(c) and (d)	View Law

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Tobacco Retailer Training Programs

Key Information

Abstract

FDA intends to issue regulations establishing standards for approved tobacco retailer training programs. In the interim, FDA published a guidance document which is intended to assist tobacco retailers to voluntarily implement effective training programs for employees. Until FDA promulgates regulations, the agency intends to use the lower maximum civil money penalties schedule for all retailers who violate the restriction of the sale and distribution of cigarettes and smokeless tobacco products, whether or not they have implemented a training program. FDA may consider further reducing the civil money penalty for retailers who have implemented a training program. Retailers who have received a Complaint for Civil Money Penalties or No-Tobacco Sale Order and who wish to submit evidence that they have a training program in place, for purposes of settlement negotiations only, may do so when filing an Answer to the Complaint.

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

21 USC 387f(d)	View Law

Pub.L. 111 - 31 103	View Law

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Recreation Survey Questions

Key Information

Abstract

Data obtained from the Recreation Survey Questions will have application to the overall effort expended throughout the Bureau of Reclamation. From the highest level in the organization to the field unit responsible for day-to-day operations and maintenance. Reclamation recreation planners and managers will use the data to help formulate decisions regarding where to plan and develop facilities, services and opportunities while concentrating financial and personnel resources to produce the highest level of public service.

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

16 USC 460	View Law

43 USC 37	View Law

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Research Performance Progress Report (RPPR)

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Abstract

Agencies are able to utilize this uniform format for reporting performance progress on Federally funded research projects. The Research Performance Progress Report (RPPR) directly benefits award recipients by making it easier for them to administer Federal grant and cooperative agreement programs through standardization of the types of information required in interim performance reports, thereby reducing their administrative effort and costs. The RPPR also makes it easier to compare the outputs, outcomes, etc. of research programs across the government.

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

42 USC 1861 et seq.	View Law

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Form USM-523A, Sequestered Juror Information Form

Key Information

Abstract

The United States Marshals Service is responsible for ensuring the security of federal courthouses, courtrooms, and federal jurist. The information collected in this form assists Marshals Service personnel in the planning of, and response to, potential security needs of the court and jurors during the course of proceedings.

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

28 USC 561	View Law

28 USC 509	View Law

28 USC 510	View Law

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Diversions, Return Flow, and Consumptive Use of Colorado River Water in the Lower Colorado River Basin

Key Information

Abstract

The United States is required to collect this information by the Supreme Court and requires water users to report this information under water delivery contracts.

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

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Pension Benefit Statement

Key Information

Abstract

Section 105(a) of the Employee Retirement Income Security Act (ERISA) requires administrators of defined contribution plans and defined benefit plans to provide periodic pension benefit statements to participants and certain beneficiaries. If a defined contribution plan permits participants and beneficiaries to direct their own investments, benefit statements must be provided at least once each quarter. If the defined contribution plan does not permit participants and beneficiaries to direct their own investments, benefit statements must be provided at least once each year. In the case of defined benefit plans, benefit statements generally must be provided at least once every three years. Section 105(a)(2)(A)(i)(I) requires a benefit statement to indicate the participant's or beneficiary's “total benefits accrued.” On December 20, 2019, ERISA section 105 was amended by section 203 of the Setting Every Community Up for Retirement Enhancement Act of 2019 (SECURE Act). As amended, ERISA section 105 requires, in relevant part, that “a lifetime income disclosure . . . be included in only one pension benefit statement provided to participants of defined contribution plans during any one 12-month period.” A lifetime income disclosure “shall set forth the lifetime income stream equivalent of the total benefits accrued with respect to the participant or beneficiary.” A lifetime income stream equivalent means the amount of monthly payments the participant or beneficiary would receive if the total accrued benefits of such participant or beneficiary were used to provide a single life annuity and a qualified joint and survivor annuity.

Federal Register Notices

60-Day FRN	View Notice

Authorizing Statutes

29 USC 1104	View Law

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Approval of Laboratories for Conducting Aquatic Animal Tests for Export Health Certificates

Key Information

Abstract

The purpose of this information collection is to provide approval to laboratories to conduct tests for the export of aquatic animals. The information collection activities permit APHIS to vet the laboratories.

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

7 USC 8301	View Law

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Semi-Annual Performance Report for the Financial Assistance to Victims of Domestic Violence, Dating Violence, Sexual Assault, and Stalking Program (FAV Program)

Key Information

Abstract

The Financial Assistance Grants for Victims of Sexual Assault, Domestic Violence, Dating Violence, and Stalking Program (hereinafter referred to as the FAV Program), supports victim service providers, Tribal governments, and Tribal organizations to provide flexible financial assistance to survivors of sexual assault, domestic violence, dating violence, and stalking. Currently, there are different statutory and regulatory reporting requirements that affect FAV Program grantees. VAWA 2000 requires all VAWA grantees, including FAV Program grantees, to report on the effectiveness of their programs.

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

Pub.L. 119 - 74 5	View Law

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Disability Report - Child

Key Information

Abstract

Sections 223(d)(5)(A) and 1631(e)(1) of the Act require Supplemental Security Income (SSI) claimants to furnish medical and other evidence to prove they are disabled. SSA uses Form SSA-3820-BK to collect information regarding a child applying for SSI disability payments. The information we collect on the SSA-3820-BK then provides the State Disability Determination Services (DDS) adjudicators a detailed explanation of a child’s medical history that is essential to the disability determination. SSA uses Form SSA-3820-BK to collect contact and biographic information about a child. It also includes details pertaining to the child’s condition including medical treating sources, medications being taken, medical tests, educational background, and work history if relevant. The State (DDS) evaluators use the information from Form SSA-3820-BK, including its electronic versions, to request and develop medical and school evidence, and to assess the alleged disability. The information collected on the form, together with medical evidence and other sources of non-medical evidence, provides the evidentiary basis upon which SSA makes its initial disability evaluation. The respondents are the responsible adult(s) applying on behalf of the child, such as the parents, guardians, and other caretakers who petition SSI childhood disability for initial and reconsideration decisions.

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

42 USC 423	View Law

42 USC 1383	View Law

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Job Corps Application Data

Key Information

Abstract

ETA 652, Job Corps Applicant Data Sheet, is critical to the screening process. This form is completed by the admissions representative in collaboration with each applicant to determine the applicant’s eligibility for the Job Corps program in accordance with WIOA and Job Corps policy and to collect socio-demographic and employment barriers information for program planning, evaluation, and data reporting purposes. This ICR also contains verbal questions on dependents and childcare.

SPD-15 Implementation	Yes

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

29 USC 3194-3195	View Law

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Application/Permit to Import Firearms, Ammunition, and Defense Articles (ATF Form 5330.3A ("Form 6, part I"))

Key Information

Abstract

The Gun Control,Act and other statutes prohibit persons from importing firearms, ammunition, and defense articles into the US unless the articles meet certain criteria, the importer is not a prohibited person, and the Attorney General (delegated to Director, ATF) approves that person to import those items. ATF uses this form to collect the information necessary to determine the above facts and approve a person to import the articles; the form then serves as their permit to do so.

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

18 USC 925	View Law

22 USC 2778	View Law

26 USC 5844	View Law

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Explosives licensee/permittee out-of-business records

Key Information

Abstract

Regulations under 27 CFR 555.128 require explosives licensees/permittees to transfer required records to the ATF Out-of-Business Records Center when they discontinue business without a successor. The records on licensee/permittee importing, manufacturing, shipping, receiving, selling, or otherwise disposing of explosive materials aid ATF in conducting investigations into trafficking and other criminal misuse of explosives.

Federal Register Notices

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30-Day FRN	View Notice

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Identification of Explosive Materials

Key Information

Abstract

To protect the public from misuse of explosives, implementing regulations at 27 CFR 555.109 require licensees/permittees to mark certain explosives they manufacture or import, as well as mark immediate containers and outside packaging. The markings must include certain information and be clear and permanent, though they can be done via sticky label, marker, etc. Some types of explosives are too small or too fluid, in a form that cannot be marked, and are excepted.

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

18 USC 923	View Law

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Pacific Cod Trawl Cooperative Program

Key Information

Abstract

This is a renewal and revision of a previously approved collection for the Pacific Cod Trawl Cooperative Program (PCTC Program). This collection contains ongoing information collection requirements submitted by participating harvesters and processors for the following forms: (1) Application for PCTC Program Cooperative Quota (CQ), (2) Application for Inter-Cooperative Transfer of CQ, (3) Application for Transfer of PCTC Program Quota Share (QS) for Processors, and (4) Notification of Intent to Process PCTC Program Pacific Cod. As part of this revision, NMFS is removing the following forms which are no longer needed: (1) Application for PCTC Program Quota Share (QS) and (2) Ninety-Day Transfer Window for Non-Exempt American Fisheries Act (AFA) License Limitation Program (LLP) holders. This revision also removes the formal appeal process for CQ allocations, as this was only used during implementation of the program. The PCTC Program is a limited access privilege program for the harvest of Pacific cod in the Bering Sea and Aleutian Islands trawl catcher vessel sector. This program is necessary to increase the value of fishery, minimize bycatch to the extent practicable, provide for the sustained participation of fishery-dependent communities, ensure the sustainability and viability of the resource, and promote safety and stability in the harvesting and processing sectors. This information collection contains the collection instruments necessary for NMFS to implement the PCTC Program and manage cooperative quota and quota share in this fishery.

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

Pub.L. 94 - 265 303	View Law

16 USC 773c	View Law

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[NCHHSTP] National HIV Surveillance System (NHSS)

Key Information

Abstract

CDC in collaboration with state and local health departments in the 50 states, the District of Columbia, and U.S. dependent areas, conducts national surveillance for cases of HIV infection that provides critical data across the spectrum of HIV disease from HIV diagnosis, to AIDS, the end-stage disease caused by infection with HIV, and death. HIV surveillance data are used to monitor the extent and characteristics of the HIV burden in the United States. In addition, this national system provides essential data to estimate HIV incidence and monitor patterns in HIV drug resistance and genetic diversity, detect HIV clusters, and perinatal exposures. This Non-Substantive Change Request is submitted to revise questions in the National HIV Surveillance System (NHSS) OMB No. 0920-0573 to align with EO 14168. Changes are only made to the Gender/Sex questions in this data collection. Modifications of other demographic questions will be done in a future Revision. There are no anticipated changes to the approved burden associated with this data collection in this Change Request. Extension of current collection set to expire 02/2026.

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

42 USC 242b	View Law

42 USC 247b	View Law

42 USC 247c	View Law

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National Implementation of the Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey (CMS-10500)

Key Information

Abstract

The information collected in the national implementation of OAS CAHPS will be used for the following purposes: -To provide a source of information from which selected measures can be publicly reported to beneficiaries to help them make informed decisions for outpatient surgery facility selection; -To aid facilities with their internal quality improvement efforts and external benchmarking with other facilities; and -To provide CMS with information for monitoring and public reporting purposes. For the mode experiment, CMS plans to use information from this mode experiment to determine whether additional mode of administration (i.e. Web data collection) should be included in the current national implementation of OAS CAHPS protocols.

SPD-15 Implementation	Yes

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

Pub.L. 111 - 148 931	View Law

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NESHAP for Coke Oven Pushing, Quenching, and Battery Stacks (40 CFR Part 63, Subpart CCCCC) (Final Rule)

Key Information

Abstract

The National Emission Standards for Hazardous Air Pollutants (NESHAP) for Coke Oven Pushing, Quenching, and Battery Stacks (40 CFR Part 63, Subpart CCCCC) were proposed on July 3, 2001 (66 FR 35325), promulgated on April 14, 2003 (68 FR 18007), and most-recently amended on August 2, 2005 (70 FR 44285). These regulations apply to pushing, soaking, quenching, and battery stacks on both existing and new coke oven batteries (coke plants) that are major sources of hazardous air pollutant (HAP) emissions. New facilities include those that commenced construction or reconstruction after the date of proposal. This information is being collected to assure compliance with 40 CFR Part 63, Subpart CCCCC. In general, all NESHAP standards require initial notifications, performance tests, and periodic reports by the owners/operators of the affected facilities. They are also required to maintain records of the occurrence and duration of any startup, shutdown, or malfunction in the operation of an affected facility, or any period during which the monitoring system is inoperative. These notifications, reports, and records are essential in determining compliance, and are required of all affected facilities subject to NESHAP. Any owner/operator subject to the provisions of this part shall maintain a file containing these documents and retain the file for at least five years following the generation date of such maintenance reports and records. All reports are sent to the delegated state or local authority. If there is no such delegated authority, the reports are sent directly to the U.S. Environmental Protection Agency (EPA) regional office. The final RTR amendments to the rule eliminate the startup, shutdown, and malfunction (SSM) exemption; remove the SSM plan requirement; add electronic submittal of notifications, semiannual reports, and performance test reports; add requirements for the control of mercury (Hg), total acid gases (hydrogen fluoride plus hydrogen chloride) (AG), hydrogen cyanide (HCN), and total polycyclic aromatic hydrocarbons (PAH) from pushing sources; Hg, particulate matter (PM), total AG, and HCN from battery stacks; Hg, PM, AG, total PAH from HRSG main stacks; and Hg PM, total AG, total PAH, and formaldehyde from HRSG bypass/waste heat stacks; and make technical and editorial changes. The remaining portions of the NESHAP remain unchanged.

Federal Register Notices

60-Day FRN	View Notice

Authorizing Statutes

44 USC 3501 et seq	View Law

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Medicare EDI Enrollment Form and EDI Registration (CMS-10164 A/B)

Key Information

Abstract

Federal law requires that CMS minimize the security risk to federal information systems. CMS is requiring that trading partners who wish to conduct the Electronic Data Interchange (EDI) transactions provide certain assurance as a condition of receiving access to the Medicare system for the purpose of conducting EDI exchanges. Health care providers, clearinghouses, and health plans that wish access to the Medicare system are required to complete this form. The information will be used to assure that those entities that access the Medicare system are aware of applicable provisions and penalties.

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

Pub.L. 104 - 191 262	View Law

Pub.L. 104 - 191 261	View Law

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QHP Issuers Data Collection for Notices for Plan or Display Errors Special Enrollment Periods (CMS-10595)

Key Information

Abstract

In the final rule, the Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017 (CMS-9937-F), we finalized 45 CFR 156.1256, which requires QHP issuers, in the case of a material plan or benefit display error included in 45 CFR 155.420(d)(12), to notify their enrollees of the error and the enrollees’ eligibility for a special enrollment period within 30 calendar days after the issuer is informed by an Federally- facilitated Exchange (FFE) that the error is corrected, if directed to do so by the FFE. This requirement provides notification to QHP enrollees of errors that may have impacted their QHP selection and enrollment and any associated monthly or annual costs, as well as the availability of a special enrollment period under §155.420(d)(12) for the enrollee to select a different QHP, if desired.

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

Pub.L. 111 - 156 1311	View Law

Pub.L. 111 - 148 402	View Law

Pub.L. 111 - 156 1312	View Law

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Strategic Prevention Framework for Prescription Drugs (SPF Rx)

Key Information

Abstract

The SPF-Rx program is designed to address nonmedical use of prescription drugs as well as opioid overdoses by raising awareness about the dangers of sharing medications and by working with pharmaceutical and medical communities. The SPF-Rx program aims to promote collaboration between states/tribes and pharmaceutical and medical communities to understand the risks of overprescribing to youth age 12–17 and adults 18 years of age and older and enhance capacity for and access to Prescription Drug Monitoring Program (PDMP) data for prevention purposes.

Federal Register Notices

60-Day FRN	View Notice
30-Day FRN	View Notice

Authorizing Statutes

42 USC 516	View Law

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