[Federal Register: January 17, 2003 (Volume 68, Number 12)]
[Notices]
[Page 2559-2560]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr17ja03-78]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare and Medicaid Services
[Document Identifier: CMS-276, CMS-1500, CMS-1490U, CMS-1490S, CMS-
1450, and CMS-R-285, CMS-R-290, and CMS-2744]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
AGENCY: Centers for Medicare and Medicaid Services.
In compliance with the requirement of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the Centers 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.
(1) Type of Information Collection Request: Revision of a Currently
Approved Collection; Title of Information Collection: Prepaid Health
Plan Cost Report; Form No.: CMS-276 (OMB 0938-0165; Use: These
forms are needed to establish the reasonable cost of providing covered
services to the enrolled Medicare population of an HMO in accordance
with Section 1876 of the Social Security Act.; Frequency: Recordkeeping
and Reporting on occasion; Affected Public: Business or other for-
profit; Number of Respondents: 45; Total Annual Responses: 225; Total
Annual Hours: 7,860.
[[Page 2560]]
(2) Type of Information Collection Request: Extension of a
currently approved collection; Title of Information Collection:
Medicare/Medicaid Health Insurance Common Claim Form, Instructions, and
Supporting Regulations: 42 CFR 424.32, 424.44; Form No.: CMS-1500, CMS-
1490U, CMS-1490S (OMB 0938-0008); Use: This form is a
standardized claim form for use in the Medicare/Medicaid programs to
apply for reimbursement for covered services. Many private insurers
also use this form. Use of this form reduces cost and administrative
burdens associated with professional claims because only one format
needs to be used and maintained. CMS does not require exclusive use of
this form for Medicaid.; Frequency: On occasion; Affected Public:
State, Local or Tribal Government, Business or other for-profit, Not-
for-profit institutions; Number of Respondents: 1,216,702; Total Annual
Responses: 740,215,135; Total Annual Hours: 42,941,276.
(3) Type of Information Collection Request: Extension of a
currently approved collection; Title of Information Collection:
Medicare Uniform Institutional Provider Bill and Supporting
Regulations; Form No.: CMS-1450 (OMB 0938-0279); Use: This
standardized form is used in the Medicare/Medicaid program to apply for
reimbursement of covered services by all providers that accept
Medicare/Medicaid assigned claims.; Frequency: On occasion; Affected
Public: Not for profit institutions and Business or other for profit;
Number of Respondents: 46,708; Total Annual Responses: 158,603,290;
Total Annual Hours: 1,666,208.
(4) Type of Information Collection Request: Extension of a
currently approved collection; Title of Information Collection: Request
for Retirement Benefit Information; Form No.: CMS-R-285 (OMB
0938-0769); Use: This information is needed to determine
whether a beneficiary meets the requirements for reduction of Part A
premium to zero.; Frequency: On occasion; Affected Public:, State and
Local or Tribal Government; Number of Respondents: 1500; Total Annual
Responses: 1500; Total Annual Hours: 208.
(5) Type of Information Collection Request: Extension of a
currently approved collection; Title of Information Collection:
Procedures for Making National Coverage Decisions; Form No.: CMS-R-0290
(OMB 0938-0776); Use: These information collection
requirements provide the process CMS will use to make a national
coverage decision for a specific item or service under sections 1862
and 1871 of the Social Security Act. This will streamline our decision
making process and will increase the opportunities for public
participation in making national coverage decisions; Frequency: Other
(as needed); Affected Public: Business or other for-profit, Not-for-
profit institutions; Number of Respondents: 200; Total Annual
Responses: 200; Total Annual Hours: 8,000.
(6) Type of Information Collection Request: Extension of a
currently approved collection; Title of Information Collection: End
Stage Renal Disease Medical Information System ESRD Facility Survey;
Form No.: CMS-2744 (OMB 0938-0447); Use: The ESRD Facility
Survey form (CMS-2744) is completed annually by Medicare-approved
providers of dialysis and transplant services. The CMS-2744 is designed
to collect information concerning treatment trends, utilization of
services and patterns of practice in treating ESRD patients.;
Frequency: Annually; Affected Public:, Business or other for-profit and
Not-for-profit institutions; Number of Respondents: 4,225; Total Annual
Responses: 4,225; Total Annual Hours: 33,800.
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://cms.hhs.gov/regulations/pra/default.asp, or e-
mail 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. 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: January 9, 2003.
John P. Burke, III,
CMS Reports Clearance Officer, Office of Strategic Operations and
Regulatory Affairs, Division of Regulations Development and Issuances.
[FR Doc. 03-1055 Filed 1-16-03; 8:45 am]
BILLING CODE 4120-03-P