[Federal Register: November 18, 2003 (Volume 68, Number 222)]
[Notices]
[Page 65072-65073]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr18no03-67]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare and Medicaid Services
[Document Identifier: CMS-901, CMS-2744, CMS-2746]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
Agency: Centers 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 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: Qualification
Application: Medicare+Choice Application for HMOs, PPOs, and State
Licensed PSOs; Medicare+Choice Application for Federally Waived PSOs;
Medicare+Choice Application for Medicare Savings Account Entities;
Medicare+Choice Application for Private Fee-for-Service Plans; Form
No.: CMS-901 (OMB 0938-0470); Use: Prepaid health plans must
meet certain regulatory requirements to be federally qualified health
maintenance organizations or to enter into a contract with CMS to
provide health benefits to Medicare beneficiaries. The application is
the collection form to obtain the information from a health plan that
will allow CMS staff to determine compliance with the regulations;
Frequency: Other: One-time submission; Affected Public: Business or
other for-profit, Not-for-profit institutions, State, Local or Tribal
Government; Number of Respondents: 55; Total Annual Responses: 55;
Total Annual Hours: 5,500.
2. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: End Stage Renal
Disease Medical Information System ESRD Facility Survey and Supporting
Regulations in 42 CFR 405.2133; 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:
[[Page 65073]]
4,360; Total Annual Responses: 4,360; Total Annual Hours: 34,880.
3. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: End Stage Renal
Disease Death Notification, P.L. 95-292; 42 CFR 405.2133; 45 CFR 5, 5b;
20 CFR Parts 401, 422E; Form No.: CMS-2746 (OMB 0938-0448);
Use: The ESRD Death Notification is to be completed upon the death of
ESRD patients. Its primary purpose is to collect fact and cause of
death. Reports of deaths are used to show cause of death and
demographic characteristics of these patients; Frequency: Other: One-
time (patient death); Affected Public: Business or other for-profit,
Not-for-profit institutions, and Federal Government; Number of
Respondents: 4,360; Total Annual Responses: 69,760; Total Annual Hours:
34,880.
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@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: November 7, 2003.
Julie Brown,
CMS Reports Clearance Officer, Office of Strategic Operations and
Strategic Affairs, Division of Regulations Development and Issuances.
[FR Doc. 03-28710 Filed 11-17-03; 8:45 am]
BILLING CODE 4120-03-P