[Federal Register: October 28, 2004 (Volume 69, Number 208)]
[Notices]
[Page 62900-62901]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr28oc04-64]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare and Medicaid Services
[Document Identifier: CMS-10113]
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.
Type of Information Collection Request: Revision of currently
approved collection; Title of Information Collection: Application for
Participation in Medicare Replacement Drug Demonstration; Use: Section
641 of the MMA mandated a demonstration that would pay for drugs/
biologicals prescribed as replacements for existing covered Medicare
drugs. A report to Congress evaluating the impact of this demonstration
was also mandated. In order to enroll in this demonstration, a
beneficiary will be required to submit the application forms.
Beneficiaries who wish to be considered for a low-income subsidy must
also provide the information on the ``Application for Financial
Assistance''; Form Number: CMS-10113 (OMB: 0938-0924);
Frequency: Other: Once per beneficiary; Affected Public: Individuals or
Households; Number of Respondents: 50,000; Total Annual Responses:
50,000; Total Annual Hours: 20,417.
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://www.cms.hhs.gov/
[[Page 62901]]
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 30 days of this notice directly to the OMB desk
officer: OMB Human Resources and Housing Branch, Attention: Christopher
Martin, New Executive Office Building, Room 10235, Washington, DC
20503.
Dated: October 21, 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. 04-24077 Filed 10-27-04; 8:45 am]
BILLING CODE 4120-03-P