[Federal Register: November 19, 2004 (Volume 69, Number 223)]
[Notices]
[Page 67744-67745]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr19no04-59]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare and Medicaid Services
[Document Identifier: CMS-10052 and CMS-370, 377, 378, R-54]
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: Extension of currently
approved collection; Title of Information Collection: Recognition of
Pass-Through Payment for Additional (new) Categories of Devices under
the Outpatient Prospective Payment System and Supporting Regulations in
42 CFR part 419; Use: Information is necessary to determine eligibility
of medical devices for establishment of additional device categories
for payment under
[[Page 67745]]
transitional pass-through payment provisions as required by section
1833(t)(6) of the Social Security Act. Form Number: CMS-10052
(OMB: 0938-0857); Frequency: On occasion; Affected Public:
Business or other for-profit; Number of Respondents: 12; Total Annual
Responses: 12; Total Annual Hours: 192.
2. Type of Information Collection Request: Revision of currently
approved collection; Title of Information Collection: Ambulatory
Surgical Center (ASC) Health Insurance Benefit Agreement, ASC Request
for Certification, ASC Survey Report and Supporting Regulations in 42
CFR 416.41, 416.43, 416.47, and 416.48; Use: The ASC Health Insurance
Benefits Agreement form is utilized for the purpose of establishing
eligibility for payment under Title XVIII of the Social Security Act.
The ASC Request for Certification form is utilized as an application
for facilities wishing to participate in the Medicare program as an
ASC. This form initiates the process of obtaining a decision as to
whether the conditions of coverage are met. It also promotes data
retrieval from the Online Data Input Edit (ODIE system, a subsystem of
the Online Survey Certification and Report (OSCAR) system by the
Centers for Medicare and Medicaid Services (CMS) Regional Offices
(RO)). The ASC Report Form is an instrument used by the State survey
agency to record data collection in order to determine supplier
compliance with individual conditions of coverage and to report it to
the Federal government. The form is primarily a coding worksheet
designed to facilitate data reduction and retrieval into the ODIE/OSCAR
system at the CMS ROs. This form includes basic information on
compliance (i.e., met, not met and explanatory statements) and does not
require any descriptive information regarding the survey activity
itself; Form Number: CMS-370, 377, 378, R-54 (OMB: 0938-0266);
Frequency: Annually and Other: once; Affected Public: State, Local or
Tribal Government; Number of Respondents: 4,312; Total Annual
Responses: 4,312; Total Annual Hours: 2,241.
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/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: November 10, 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. 04-25720 Filed 11-18-04; 8:45 am]
BILLING CODE 4120-03-P