[Federal Register: February 24, 2006 (Volume 71, Number 37)]
[Notices]
[Page 9560-9561]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr24fe06-87]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-1500 (12-90), CMS-1490U, CMS-1490S, CMS-1500
(08-05)]
Agency Information Collection Activities: Submission for OMB
Review; 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), 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 function; (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: Health Insurance
Common Claims Form and Supporting Regulations at 42 CFR part 424,
subpart C; Form Number: CMS-1500 (12-90), CMS-1490-U, CMS-1490-S
(OMB: 0938-0008); Use: The Form CMS-1500 answers the needs of
many health insurers. It is the basic form prescribed by CMS for the
Medicare program and is only accepted from physicians and suppliers
that are excluded from the mandatory electronic claims submission
requirements set forth in the Administrative Simplification Compliance
Act (ASCA) Public Law 107-105 and the implementing regulation at 42 CFR
424.32. The Medicaid State Agencies, CHAMPUS/TriCare, Office of
Workers' Compensation Programs (OWCP), U.S. Railroad Retirement Board
(RRB), Blue Cross/Blue Shield Plans, the Federal Employees Health
Benefit Plan, and several private health plans also use it; it is the
de facto standard ``professional'' claim form. CMS is seeking re-
approval of the CMS-1500 (12/90), CMS-1490-U, and the CMS-1490-S
forms.; Frequency: Reporting--On occasion; Affected Public: State,
Local, or Tribal Government, Business or other-for-profit, Not-for-
profit institutions; Number of Respondents: 902,378; Total Annual
Responses: 957,204,707; Total Annual Hours: 46,383,364.
2. Type of Information Collection Request: New collection; Title of
Information Collection: Health Insurance Common Claims Form and
Supporting Regulations at 42 CFR part 424, subpart C; Form Number: CMS-
1500 (08-05), CMS-1490-S (OMB: 0938-NEW); Use: CMS is
simultaneously seeking approval for form CMS-1500 (08-05) and the CMS-
1500 (12-90). A concurrent approval for the two forms is needed to
allow the industry to prepare for the conversion, i.e. computer system
conversions and mass printing of the form CMS-1500 (08-05). The CMS-
1500 (08-05) will be accepted beginning in October, 2006. Its use will
be mandatory in 2007. In 2007, the CMS-1500 (12-90) and the
corresponding OMB control number will be discontinued. The Form CMS-
1500 answers the needs of many health insurers. It is the basic form
prescribed by CMS for the Medicare program and is only accepted from
physicians and suppliers that are excluded from the mandatory
electronic claims submission requirements set forth in the
Administrative Simplification Compliance Act (ASCA) Public Law 107-105
and the implementing regulation at 42 CFR 424.32. The Medicaid State
Agencies, CHAMPUS/TriCare, Office of Workers' Compensation Programs
(OWCP), U.S. Railroad Retirement Board (RRB), Blue Cross/Blue Shield
Plans, the Federal
[[Page 9561]]
Employees Health Benefit Plan, and several private health plans also
use it; it is the de facto standard ``professional'' claim form.;
Frequency: Reporting--On occasion; Affected Public: State, Local, or
Tribal Government, Business or other-for-profit, Not-for-profit
institutions; Number of Respondents: 902,378; Total Annual Responses:
957,204,707; Total Annual Hours: 46,383,364.
To obtain copies of the supporting statement and any related forms
for these paperwork collections referenced above, access CMS Web site
address at http://www.cms.hhs.gov/PaperworkReductionActof1995, 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.
To be assured consideration, comments and recommendations for the
proposed information collections must be received by the OMB Desk
Officer at the address below, no later than 5 p.m. on March 27, 2006.
OMB Human Resources and Housing Branch, Attention: Carolyn Lovett, CMS
Desk Officer, New Executive Office Building, Room 10235, Washington, DC
20503.
Dated: February 16, 2006.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. 06-1769 Filed 2-23-06; 8:45 am]
BILLING CODE 4120-01-P