[Federal Register: January 30, 2004 (Volume 69, Number 20)]
[Notices]
[Page 4521]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr30ja04-68]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare and Medicaid Services
[Document Identifier: CMS-10101, CMS-10093, CMS-304&304a, CMS-565, and
CMS-R-246]
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: New collection; Title of
Information Collection: Survey of Medicare Preferred Provider
Organization Demonstration Form No.: CMS-10101 (OMB 0938-NEW);
Use: This information collection will be used to collect information
from Medicare Beneficiaries to understand beneficiary experiences with
the new managed care option and to understand which Medicare
beneficiaries are attracted to the PPO model and why. CMS also wants to
know what both enrollees and non-enrollees in PPOs know and understand
about this new option; Frequency: Other: One-time Only; Affected
Public: Individuals or Households; Number of Respondents: 38,216; Total
Annual Responses: 38,216; Total Annual Hours: 9,556.
2. Type of Information Request: Extension of a currently approved
collection; Type of Information Collection: CMS/AoA Aging and
Disability Resource Center Grant Program; CMS Form Number: CMS-10093
(OMB 0938-0903); Use: Information sought by CMSO/DEHPG is
needed to award competitive grants to States to develop Aging and
Disability Resource Centers; Frequency: Semi-annually; Affected Public:
State, local, or tribal government, Not-for-profit institutions,
Business or other for-profit; Number of Respondents: 24; Total Annual
Responses: 48; Total Annual Burden Hours: 960.
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicaid Drug
Rebate; Form No.: CMS-304 and CMS-304a (OMB 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.
4. 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.
5. 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.
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: January 22, 2004.
Melissa Musotto,
Acting Paperwork Reduction Act Team Leader, CMS Reports Clearance
Officer, Office of Strategic Operations and Strategic Affairs, Division
of Regulations Development and Issuances.
[FR Doc. 04-1984 Filed 1-29-04; 8:45 am]
BILLING CODE 4120-03-P