[Federal Register: April 29, 2005 (Volume 70, Number 82)]
[Notices]
[Page 22317]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr29ap05-46]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-10117, 10118, 10119, 10135, 10136 and CMS-R-
138]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Centers for Medicare & 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 & Medicaid
Services (CMS) 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: Medicare
Advantage Application for Coordinated Care, Private Fee-for-Service,
Regional Preferred Provider Organization, Service Area Expansion for
Coordinated Care and Private Fee-for-Service Plans, Medical Savings
Account Plans; Form Nos.: CMS-10117, 10118, 10119, 10135, 10136 (OMB
0938-0935); Use: Health plans must meet certain regulatory
requirements to enter into a contract with CMS to provide health
benefits to Medicare beneficiaries. These applications are the
collection forms to obtain the information from a health plan that will
allow CMS staff to determine compliance with the regulations;
Frequency: Other--one-time submission; Affected Public: Business or
other for-profit, Not-for-profit institutions, and State, Local or
Tribal Government; Number of Respondents: 420; Total Annual Responses:
520; Total Annual Hours: 20,100.
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Medicare
Geographic Classification Review Board (MGCRB) Procedures and
Supporting Regulations in 42 CFR Sections 412.256 and 412.230; Form
Nos.: CMS-R-138 (OMB 0938-0573); Use: Section 1886(d)(10) of
the Social Security Act established the Medicare Geographic
Classification Review Board (MGCRB), an entity with the authority to
accept short-term hospital inpatient prospective payment system
applications from hospitals requesting geographic reclassification for
wage index or standardized payment amounts and to issue decisions on
these requests. This regulation sets up the application process for
prospective payment system hospitals that choose to appeal their
geographic status to the MGCRB. This regulation also establishes
procedural guidelines for the MGCRB; Frequency: Reporting--Annually;
Affected Public: Business or other for-profit, Not-for-profit
institutions; Number of Respondents: 500; Total Annual Responses: 500;
Total Annual Hours: 500.
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@cms.hhs.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 to the address
below:CMS, Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development,Attention: Melissa Musotto, PRA
Specialist,Room C4-26-05,7500 Security Boulevard,Baltimore, Maryland
21244-1850.
Dated: April 22, 2005.
Michelle Shortt,
Acting Director, Regulations Development Group, Office of Strategic
Operations and Regulatory Affairs.
[FR Doc. 05-8713 Filed 4-28-05; 8:45 am]
BILLING CODE 4120-01-P