[Federal Register: May 14, 2004 (Volume 69, Number 94)]
[Notices]
[Page 26841]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr14my04-48]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-R-214, CMS-179, CMS-367, 367-A, 367-C and
CMS-417]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
AGENCY: Centers for Medicare & 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 & 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: Extension of a currently
approved collection; Title of Information Collection: Independent
Diagnostic Testing Facility and Supporting Regulations contained in 42
CFR 410.33; Form No.: CMS-R-214 (OMB 0938-0721); Use: The
information collection requirements associated with an Independent
Diagnostic Testing Facilities involve documentation of proficiency of
medical personnel and of resources; Frequency: Annually; Affected
Public: Business or other for-profit, Federal Government and State,
local and tribal government; Number of Respondents: 500; Total Annual
Responses: 500; Total Annual Hours: 42.
2. Type of Information Request: Extension of a currently approved
collection; Title of Information Collection: Transmittal and Notice of
Approval of State Plan Material and Supporting Regulations in 42 CFR
430.10-430.20 and 440.167; Form Number: CMS-179 (OMB approval
: 0938-0193); Use: Form CMS-179 is used by State agencies to
transmit State plan material to CMS for approval prior to amending
their State plans; Frequency: On occasion; Affected Public: State,
local or tribal gov't; Number of Respondents: 56; Total Annual
Responses: 56; Total Annual Hours Requested: 560.
3. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Medicaid Drug
Rebate Program--Manufacturers; Form No.: 0938-0578 (CMS-367, 367a, and
367c); Use: Section 1927 requires drug manufacturers to enter into and
have in effect a rebate agreement with the Federal Government for
States to receive funding for drugs dispensed to Medicaid recipients;
Frequency: Quarterly; Affected Public: Business or other for-profit;
Number of Respondents: 570; Total Annual Responses: 2,280; Total Annual
Hours: 54,780.
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Hospice Request
for Certification in the Medicare Program; Form No.: CMS-417
(OMB 0938-0313); Use: The Hospice Request for Certification
Form is used for hospice identification, screening, and to initiate the
certification process. The information captured on this form is entered
into a data base which assists CMS in determining whether providers
have sufficient personnel to participate in the Medicare program;
Frequency: Annually; Affected Public: Business or other for-profit,
Not-for-profit institutions, Federal Government, and State, local or
tribal government; Number of Respondents: 2,286; Total Annual
Responses: 2,286; Total Annual Hours: 572.
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: May 6, 2004.
John P. Burke, III,
Paperwork Reduction Act Team Leader, CMS Reports Clearance Officer,
Office of Strategic Operations and Regulatory Affairs, Division of
Regulations Development and Issuances.
[FR Doc. 04-10988 Filed 5-13-04; 8:45 am]
BILLING CODE 4120-03-P