[Federal Register: February 13, 2004 (Volume 69, Number 30)]
[Notices]
[Page 7229-7230]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr13fe04-79]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare and Medicaid Services
[Document Identifier: CMS-1491, CMS-R-26, CMS-1728, CMS-2540 and CMS-
10098]
Agency Information Collection Activities: Submission for OMB
Review; 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: Extension of a currently
approved collection; Title of Information Collection: Request for
Medicare Payment--Ambulance and Supporting Regulations in 42 CFR
Sections 410.1, 410.40, 424.124, 414.601, 414.605, 414.610, 414.611,
414.615, 414.620, and 414.625.; Form No.: CMS-1491 (OMB 0938-
0042); Use: This paper form is completed on an occasion basis by
beneficiaries and/or ambulance suppliers. Also, it is submitted to a
Medicare carrier to request payment for ambulance services.; Frequency:
On occasion; Affected Public: Business or other for-profit, individuals
or households, and not-for-profit institutions; Number of Respondents:
9,301,183; Total Annual Responses: 9,301,183; Total Annual Hours:
331,643.
2. Type of Information Request: Revision of a currently approved
collection; Title of Information Collection: Information Collection
Requirements (ICR) Contained in the Clinical Laboratory Improvement
Amendments (CLIA) Regulations 42 CFR part 493.801, 493.803, 493.1232,
493.1233, 493.1234, 493.1235, 493.1236, 493.1239, 493.1241, 493.1242,
493.1249, 493.1251, 493,1252, 493.1253, 493.1254, 493.1255, 493.1256,
493.1261, 493.1262, 493.1263, 493.1269, 493.1273, 493.1274, 493.1278,
493.1283, 493.1289, 493.1291, and 493.1299; Form Number: CMS-R-26 (OMB
approval : 0938-0612); Use: The ICRs referenced in specified
sections of 42 CFR part 493 outline the requirements necessary to
determine an entity's compliance with CLIA. CLIA requires laboratories
that perform testing on human beings to meet performance requirements
(quality
[[Page 7230]]
standards) in order to be certified by HHS; Frequency: Other: As
needed; Affected Public: Business or other for-profit, not-for-profit
institutions, Federal government, State, local or tribal gov't; Number
of Respondents: 82,220; Total Annual Responses: 111,354,920; Total
Annual Hours Requested: 9,887,917.
3. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Home Health
Agency Cost Report and Supporting Regulations in 42 CFR 413.20, 413.24
and 413.106; Form No.: CMS-1728 (OMB 0938-0022); Use:
Participating providers are required to submit annual information to
CMS in order to achieve settlement of costs for health care services
rendered to Medicare beneficiaries. The CMS-1728 is the form used by
Home Health Agencies to report their health care costs to determine the
amount reimbursable for services furnished to Medicare beneficiaries;
Frequency: Annually; Affected Public: Business or other for profit, not
for profit institutions, and State, Local or Tribal Gov.; Number of
Respondents: 7,310; Total Annual Responses: 7,310; Total Annual Hours
Requested: 1,311,060.
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Skilled Nursing
Facility Cost Report and Supporting Regulations in 42 CFR 413.20,
413.24, and 413.106; Form No.: CMS-2540-96 (OMB 0938-0463); Use: Form
CMS-2540-96 is the form used by skilled nursing facilities
participating in the Medicare program. This form reports the health
care costs used to determine the amount of reimbursable costs for
services rendered to Medicare beneficiaries; Frequency: Annually;
Affected Public: Businesses or other for-profit; not-for-profit
institutions and State, Local or Tribal Government; Number of
Respondents: 13,000; Total Annual Responses: 13,000; Total Annual
Hours: 2,480,000.
5. Type of Information Collection Request: New Collection; Title of
Information Collection: 1-800-Medicare Beneficiary Satisfaction Survey;
Form No.: CMS-10098 (OMB 0938-NEW); Use: The Beneficiary
Satisfaction survey is performed to insure that the CMS 1-800-Medicare
helpline contractor is delivering satisfactory service to the Medicare
beneficiaries. It gathers data on several helpline operations such as
print fulfillment and website tools hosted on http://www.medicare.gov.
Respondents to the survey are Medicare beneficiaries that have
contacted the 1-800-Medicare number within the past week for benefits
and services information.; Frequency: On occasion; Affected Public:
Individuals or households; Number of Respondents: 14,400; Total Annual
Responses: 14,400; Total Annual Hours: 1,800.
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: February 5, 2004.
John P. Burke, III,
Paperwork Reduction Act Team Leader, CMS Reports Clearance Officer,
Office of Strategic Operations and Strategic Affairs, Division of
Regulations Development and Issuances.
[FR Doc. 04-3160 Filed 2-12-04; 8:45 am]
BILLING CODE 4120-03-P