Agency Information Collection Activities: Proposed Collection; Comment Request, 4128 [05-1482]
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Federal Register / Vol. 70, No. 18 / Friday, January 28, 2005 / Notices
provisions as required by section
1833(t)(6) of the Social Security Act.
Transitional pass-through payments
have been made to hospitals for certain
drugs, biologicals, and medical devices;
Frequency: On occasion; Affected
Public: Business or other for-profit;
Number of Respondents: 15; Total
Annual Responses: 15; Total Annual
Hours: 180.
To obtain copies of the supporting
statement and any related forms for the
proposed paperwork collections
referenced above, access CMS Web site
address at https://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 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: January 19, 2005.
John P. Burke, III,
CMS Paperwork Reduction Act Reports
Clearance Officer, Office of Strategic
Operations and Regulatory Affairs,
Regulations Development Group.
[FR Doc. 05–1481 Filed 1–27–05; 8:45 am]
BILLING CODE 4120–03–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–1771, CMS–R–
71 and CMS–222]
Agency Information Collection
Activities: Proposed Collection;
Comment Request
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;
AGENCY:
VerDate jul<14>2003
15:43 Jan 27, 2005
Jkt 205001
(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: Attending
Physicians Statement and
Documentation of Medicare Emergency
and Supporting Regulations in 42 CFR,
Section 424.103; Use: Payment may be
made for certain part A inpatient
hospital services and part B outpatient
provided in a nonparticipating U.S. or
foreign hospital when services are
necessary to prevent the death or
serious impairment of the health of the
individual. This collection is used to
document the attending physician’s
statement that the hospitalization was
required due to an emergency and give
clinical support for the claim.; Form
Number: CMS–1771 (OMB#: 0938–
0023); Frequency: On Occasion;
Affected Public: Business or other forprofit; Number of Respondents: 200;
Total Annual Responses: 200; Total
Annual Hours: 50.
2. Type of Information Collection
Request: Extension of a Currently
Approved Collection; Title of
Information Collection: Quality
Improvement Organization (QIO)
Assumption of Responsibilities and
Supporting Regulations in 42 CFR
Sections 412.44, 412.46, 431.630,
476.71, 476.73, 476.74, 476.78; Form
No.: CMS–R–71 (OMB# 0938–0445);
Use: This collection describes the
review functions to be performed by the
QIO. It outlines relationships among
QIOs, providers, practitioners,
beneficiaries, intermediaries, and
carriers. QIOs assure that covered care
provided to Medicare patients is
reasonable, medically necessary,
appropriate, and of a quality that meets
professionally recognized standards of
care, and that inpatient services could
not be more appropriately provided on
an outpatient basis or in a different type
of facility.; Frequency: As Needed;
Affected Public: Business or other forprofit; Number of Respondents: 6,036;
Total Annual Responses: 6,036; Total
Annual Hours: 81,818.
3. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Independent
Rural Health Center/Freestanding
Federally Qualified Health Center Cost
Report and Supporting Regulations in
42 CFR, Section 413.20 and 413.24;
PO 00000
Frm 00045
Fmt 4703
Sfmt 4703
Form No.: CMS–222 (OMB#0938–0107);
Use: The independent rural health
clinic/freestanding federally qualified
health center cost report is the cost
report to be used by the mentioned
clinics/centers to submit annual
information. This information is used to
achieve a settlement of costs for health
care services rendered to Medicare
beneficiaries. Frequency: Annually;
Affected Public: Not-for-Profit
institutions, Business or other for-profit,
and State, local or tribal government;
Number of Respondents: 3,000; Total
Annual Responses: 3,000; Total Annual
Hours Requested: 150,000.
To obtain copies of the supporting
statement and any related forms for the
proposed paperwork collections
referenced above, access CMS’’ Web site
address at https://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 directly to
the CMS Paperwork Reduction Act
Reports Clearance Officer designated at
the address below: CMS, Office of
Strategic Operations and Regulatory
Affairs, Division of Regulations
Development, Attention: Melissa
Musotto, Room C5–14–03, 7500
Security Boulevard, Baltimore,
Maryland 21244–1850.
Dated: January 19, 2005.
John P. Burke, III,
CMS Paperwork Reduction Act Reports
Clearance Officer, Office of Strategic
Operations and Regulatory Affairs,
Regulations Development Group.
[FR Doc. 05–1482 Filed 1–27–05; 8:45 am]
BILLING CODE 4120–03–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare and Medicaid
Services
[Document Identifier: CMS–10132]
Emergency Clearance: Public
Information Collection Requirements
Submitted to the Office of Management
and Budget (OMB)
Agency: Center 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), Department of Health
E:\FR\FM\28JAN1.SGM
28JAN1
]]>Agencies
[Federal Register Volume 70, Number 18 (Friday, January 28, 2005)]
[Notices]
[Page 4128]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-1482]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-1771, CMS-R-71 and CMS-222]
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: Attending
Physicians Statement and Documentation of Medicare Emergency and
Supporting Regulations in 42 CFR, Section 424.103; Use: Payment may be
made for certain part A inpatient hospital services and part B
outpatient provided in a nonparticipating U.S. or foreign hospital when
services are necessary to prevent the death or serious impairment of
the health of the individual. This collection is used to document the
attending physician's statement that the hospitalization was required
due to an emergency and give clinical support for the claim.; Form
Number: CMS-1771 (OMB: 0938-0023); Frequency: On Occasion;
Affected Public: Business or other for-profit; Number of Respondents:
200; Total Annual Responses: 200; Total Annual Hours: 50.
2. Type of Information Collection Request: Extension of a Currently
Approved Collection; Title of Information Collection: Quality
Improvement Organization (QIO) Assumption of Responsibilities and
Supporting Regulations in 42 CFR Sections 412.44, 412.46, 431.630,
476.71, 476.73, 476.74, 476.78; Form No.: CMS-R-71 (OMB 0938-
0445); Use: This collection describes the review functions to be
performed by the QIO. It outlines relationships among QIOs, providers,
practitioners, beneficiaries, intermediaries, and carriers. QIOs assure
that covered care provided to Medicare patients is reasonable,
medically necessary, appropriate, and of a quality that meets
professionally recognized standards of care, and that inpatient
services could not be more appropriately provided on an outpatient
basis or in a different type of facility.; Frequency: As Needed;
Affected Public: Business or other for-profit; Number of Respondents:
6,036; Total Annual Responses: 6,036; Total Annual Hours: 81,818.
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Independent Rural
Health Center/Freestanding Federally Qualified Health Center Cost
Report and Supporting Regulations in 42 CFR, Section 413.20 and 413.24;
Form No.: CMS-222 (OMB0938-0107); Use: The independent rural
health clinic/freestanding federally qualified health center cost
report is the cost report to be used by the mentioned clinics/centers
to submit annual information. This information is used to achieve a
settlement of costs for health care services rendered to Medicare
beneficiaries. Frequency: Annually; Affected Public: Not-for-Profit
institutions, Business or other for-profit, and State, local or tribal
government; Number of Respondents: 3,000; Total Annual Responses:
3,000; Total Annual Hours Requested: 150,000.
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, access CMS''
Web site address at https://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 directly to
the CMS Paperwork Reduction Act Reports Clearance Officer designated at
the address below: CMS, Office of Strategic Operations and Regulatory
Affairs, Division of Regulations Development, Attention: Melissa
Musotto, Room C5-14-03, 7500 Security Boulevard, Baltimore, Maryland
21244-1850.
Dated: January 19, 2005.
John P. Burke, III,
CMS Paperwork Reduction Act Reports Clearance Officer, Office of
Strategic Operations and Regulatory Affairs, Regulations Development
Group.
[FR Doc. 05-1482 Filed 1-27-05; 8:45 am]
BILLING CODE 4120-03-P
