[Federal Register: November 7, 2003 (Volume 68, Number 216)]
[Notices]
[Page 63104-63106]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr07no03-79]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare and Medicaid Services
[Document Identifier: CMS-565, CMS-9044, CMS-P-0015A, CMS-1491, CMS-R-
13, CMS-R-246, CMS-R-204, CMS-304 and 304a]
Agency Information Collection Activities: Proposed Collection;
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
[[Page 63105]]
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: Extension of a currently
approved collection; Title of Information Collection: Medicare
Qualification Statement for Federal Employees and Supporting
Regulations in 42 CFR 406.15; Form No.: CMS-565 (OMB 0938-
0501); Use: The CMS-565 is completed by individuals filing for hospital
insurance ([HI] Part A) benefits based upon their federal employment.
This information is needed to determine if SSA/CMS can use (deem)
federal employment prior to 1983 to provide quarters of coverage so the
individual can qualify for free hospital insurance.; Frequency: Other:
One-time-only; Affected Public: Individuals or Households, Federal
Government, State, Local, or Tribal Government; Number of Respondents:
4,300; Total Annual Responses: 4,300; Total Annual Hours: 717.
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Provider
Reimbursement Manual, Part 1--Chapter 27, Sections 2721, 2722 and 2725,
Request for Exception to End Stage Renal Disease Composite Rates and
Supporting Regulations in 42 CFR 413.170 and 413.184; Form No.: CMS-
9044 (OMB 0938-0296); Use: This information collection
describes the information End Stage Renal Disease facilities must
submit in justifying an exception request to their composite rate for
outpatient dialysis services; Frequency: On occasion; Affected Public:
Business or other for-profit, Not-for-profit institutions, and Federal
Government; Number of Respondents: 125; Total Annual Responses: 125;
Total Annual Hours: 6,000.
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare Current
Beneficiary Survey (MCBS): Rounds 38-46; Form No.: CMS-P-0015A
(OMB 0938-0568); Use: The MCBS is a continuous, multipurpose
survey of a nationally representative sample of aged and disabled
persons enrolled in Medicare. The survey provides a comprehensive
source of information on beneficiary characteristics, needs,
utilization, and satisfaction with Medicare-related activities;
Frequency: Other: 3 times a year; Affected Public: Individuals or
Households, Business or other for-profit, and Not-for-profit
institutions; Number of Respondents: 16,500; Total Annual Responses:
49,500; Total Annual Hours: 50,325.
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Request for
Medicare Payment--Ambulance and Supporting Regulations in 42 CFR
Sections 410.1, 410.40, 424.124, 414.601, 414.605, 414.610, 414.611,
414.615, 414.620, and 414.625; Form No.: CMS-1491 (OMB 0938-
0042); Use: This paper form is completed on an occasion basis by
beneficiaries and/or ambulance suppliers. Also, it is submitted to a
Medicare carrier to request payment for ambulance services; Frequency:
On occasion; Affected Public: Business or other for-profit, Individuals
or Households, and Not-for-profit institutions; Number of Respondents:
9,301,183; Total Annual Responses: 9,301,183; Total Annual Hours:
390,493.
5. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Conditions of
Coverage for Organ Procurement Organizations (OPOs) and Supporting
Regulations in 42 CFR, Sections 486.304, 486.306, 486.307, 486.310,
486.316, 486.318, and 486.325; Form No.: CMS-R-13 (OMB 0938-
0688); Use: Organ Procurement Organizations are required to submit
accurate data to CMS concerning population and information on donors
and organs on an annual basis in order to assure maximum effectiveness
in the procurement and distribution of organs; Frequency: Annually;
Affected Public: Not-for-profit institutions; Number of Respondents:
59; Total Annual Responses: 59; Total Annual Hours: 59,000.
6. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare Consumer
Assessment of Health Plan Survey--Medicare + Choice (CAHPS-M+C); Form
No.: CMS-R-246(OMB 0938-0732); Use: Under the Balanced Budget
Act of 1997, CMS is required to provide general and plan comparative
information to beneficiaries that will help them make more informed
health plan choices. A CAHPS fee-for-service survey is needed to
provide information comparable to those data collected from the CAHPS
managed care survey; Frequency: Annually; Affected Public: Individuals
or Households; Number of Respondents: 168,000; Total Annual Responses:
168,000; Total Annual Hours: 55,450.
7. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Data Collection
for the Second Generation Social Health Maintenance Organization
Demonstration; Form No.: CMS-R-204 (OMB 0938-0709; Use: The
Centers for Medicare and Medicaid Services will continue to use the
data collected under this effort to support the operational needs of
the congressionally mandated and administratively extended Second
Generation of the Social Health Maintenance Organization
Demonstration.; Frequency: Annually; Affected Public: Individuals or
Households; Number of Respondents: 15,000; Total Annual Responses:
15,000; Total Annual Hours: 4,950.
8. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicaid Drug
Rebate; Form No.: CMS-304 and 304a (0938-0676); Use: Section 1927 of
the Social Security Act requires State Medicaid agencies to report to
drug manufacturers and CMS on the drug utilization for their State and
the amount of rebate to be paid by the manufacturer; Frequency:
Quarterly; Affected Public: State, local, or tribal government; Number
of Respondents: 51; Total Annual Responses: 204; Total Annual Hours:
6,125.
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, access CMS's
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@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 60 days of this notice directly to the CMS Paperwork Clearance
Officer designated at the following address: CMS, Office of Strategic
Operations and
[[Page 63106]]
Regulatory Affairs, Division of Regulations Development and Issuances,
Attention: Melissa Musotto, Room C5-14-03, 7500 Security Boulevard,
Baltimore, Maryland 21244-1850.
Dated: October 30, 2003.
Julie Brown,
CMS Reports Clearance Officer, Office of Strategic Operations and
Strategic Affairs, Division of Regulations Development and Issuances.
[FR Doc. 03-28090 Filed 11-6-03; 8:45 am]
BILLING CODE 4120-03-P