[Federal Register: June 16, 2004 (Volume 69, Number 115)]
[Notices]
[Page 33642-33643]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr16jn04-59]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare and Medicaid Services
[Document Identifier: CMS-10111 and CMS-R-263]
Agency Information Collection Activities: Proposed Collection;
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: New Collection; Title of
Information Collection: Notice of Exclusions from Medicare Benefits-
Home Health Agency and Supporting Regulations in 42 CFR 484.10; Form
No.: CMS-10111 (OMB 0938-NEW); Use: Whenever a Home Health
Agency reduces or terminates home health services, the home health
agency must give notice; Affected Public: Business or other for-profit,
Individuals or
[[Page 33643]]
Households, and Not-for-profit institutions; Number of Respondents:
6,813; Total Annual Responses: 534,295; Total Annual Hours: 534,429.5.
2. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: On-site
Inspection for Durable Medicare Equipment (DME) Supplier Location and
Supporting Regulations in 42 CFR, Section 424.57; Form No.: CMS-R-263
(OMB 0938-0749); Use: CMS collects information on any supplier
who submits bills to Medicare or who applies for a Medicare Billing
Number before allowing the supplier to enroll. This information must
minimally clearly identify the provider and its place of business as
required in Pub. L. 99-272 Section 9202(g) and provide all necessary
documentation to prove that they are qualified to perform the services
for which they are billing. The on-site inspection for Durable Medical
Equipment (DME) Supplier Location verifies this information; Affected
Public: Business or other for-profit, Not-for-profit institutions, and
State, Local, or Tribal Gov.; Number of Respondents: 20,000; Total
Annual Responses: 20,000; Total Annual Hours: 10,000.
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://www.cms.hhs.gov/regulations/pra/, 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 Regulatory Affairs,
Division of Regulations Development and Issuances, Attention: Melissa
Musotto, Room C5-14-03, 7500 Security Boulevard, Baltimore, Maryland
21244-1850.
Dated: June 8, 2004.
John P. Burke, III,
Paperwork Reduction Act Team Leader, Office of Strategic Operations and
Strategic Affairs, Division of Regulations Development and Issuances.
[FR Doc. 04-13505 Filed 6-15-04; 8:45 am]
BILLING CODE 4120-03-P