Agency Information Collection Activities: Submission for OMB Review; Comment Request, 35711-35713 [E7-12655]
Download as PDF
Federal Register / Vol. 72, No. 125 / Friday, June 29, 2007 / Notices
continued participation in the federal
Medicaid fraud control grant program.
Frequency: Annually.
Affected Public: State, Local or Tribal
Government.
Annual Number of Respondents: 49.
Total Annual Responses: 98.
Average Burden per Response: 46.5
hours.
Total Annual Hours: 4557.
To obtain copies of the supporting
statement and any related forms for the
proposed paperwork collections
referenced above, e-mail your request,
including your address, phone number,
OMB number, and OS document
identifier, to
Sherette.funncoleman@hhs.gov, or call
the Reports Clearance Office on (202)
690–6162. Written comments and
recommendations for the proposed
information collections must be
received within 30 days of this notice
directly to the Desk Officer at the
address below:
OMB Desk Officer: John Kraemer, OMB
Human Resources and Housing
Branch, Attention: (OMB #0990–
0162), New Executive Office Building,
Room 10235, Washington, DC 20503.
Dated: June 20, 2007.
Alice Bettencourt,
Office of the Secretary, Paperwork Reduction
Act Reports Clearance Officer.
[FR Doc. E7–12620 Filed 6–28–07; 8:45 am]
BILLING CODE 4152–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Office of the Secretary
[Document Identifier: OS–0990–0000; 30day notice]
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Office of the Secretary, HHS.
In compliance with the requirement
of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the
Office of the Secretary (OS), Department
of Health and Human Services, is
publishing the following summary of a
proposed collection 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
mstockstill on PROD1PC66 with NOTICES
AGENCY:
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be collected; and (4) the use of
automated collection techniques or
other forms of information technology to
minimize the information collection
burden.
Type of Information Collection
Request: Regular, New Collection.
Title of Information Collection: The
Role of Faith-based and Community
Organizations in Post-Hurricane Human
Services Relief Efforts.
Form/OMB No.: 0990-new.
Use: The Office of the Assistant
Secretary for Planning and Evaluation
will study the role of faith-based and
community organizations in Louisiana,
Mississippi, and Houston to document
and analyze the human services relief
efforts conducted and organizational
networks used in the aftermath of
hurricanes Katrina and Rita in 2005.
This information will be used to
improve future disaster planning and
response by government and other
relevant organizations.
Frequency: One-time collection.
Affected Public: Non-profit
organizations; government officials;
individuals.
Annual Number of Respondents: 390.
Total Annual Responses: 390.
Average Burden per Response: 41.8
minutes.
Total Annual Hours: 271.7 hours.
To obtain copies of the supporting
statement and any related forms for the
proposed paperwork collections
referenced above, e-mail your request,
including your address, phone number,
OMB number, and OS document
identifier, to
Sherette.funncoleman@hhs.gov, or call
the Reports Clearance Office on (202)
690–6162. Written comments and
recommendations for the proposed
information collections must be
received within 30 days of this notice
directly to the Desk Officer at the
address below:
OMB Desk Officer: John Kraemer, OMB
Human Resources and Housing
Branch, Attention: (OMB #0990–
0000), New Executive Office Building,
Room 10235, Washington, DC 20503.
Dated: June 20, 2007.
Alice Bettencourt,
Office of the Secretary. Paperwork Reduction
Act Reports Clearance Officer.
[FR Doc. E7–12621 Filed 6–28–07; 8:45 am]
BILLING CODE 4150–05–P
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35711
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–R–26, CMS–
10217, CMS–R–297, CMS–10223, and CMS–
1500 (08–05)]
Agency Information Collection
Activities: Submission for OMB
Review; 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), 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 without change of a
currently approved collection; Title of
Information Collection: Information
Collection Requirements (ICRs)
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,
439.1253, 493.1254, 493.1255, 493.1256,
493.1261, 493.1262, 493.1263, 493.1269,
493.1273, 493.1274, 493.1278, 493.1283,
493.12889, 493.1291, and 493.1299;
Form Numbers: CMS–R–26 (OMB#:
0938–0612); Use: The ICRs referenced in
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
standards) in order to be certified by the
Department of Health and Human
Services (HHS). HHS conducts
inspections to determine a laboratory’s
compliance with CLIA requirements.
CLIA implements the certificate,
laboratory standards and inspection
AGENCY:
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29JNN1
mstockstill on PROD1PC66 with NOTICES
35712
Federal Register / Vol. 72, No. 125 / Friday, June 29, 2007 / Notices
requirements; Frequency: Reporting—As
needed; Affected Public: State, Local or
Tribal Governments, Federal
Government, Business or Other for
profits and Not-for-profit institutions;
Number of Respondents: 168,688; Total
Annual Responses: 756,241; Total
Annual Hours: 11,363,680.
2. Type of Information Collection
Request: New collection; Title of
Information Collection: Physician
Survey for the 2006 Medicare Oncology
Demonstration Program; Form Numbers:
CMS–10217 (OMB#: 0938–New); Use:
The 2006 Oncology Demonstration
Program aimed to: (1) Have oncology
payments increasingly focused on
patient-centered care, rather than
chemotherapy administration; (2) learn
to what extent Medicare beneficiaries
are being treated in a manner that yields
the best outcomes; (3) understand
clinical cancer scenarios where there is
not clinical consensus among
physicians on the relevance of specific
evidence-based practice guidelines; and,
(4) ensure that due emphasis is placed
on multi-disciplinary, comprehensive
approach to palliation and end of life
care. In addition, CMS hoped to reduce
the potential that unnecessary services
and tests are being performed, thereby
lowering program costs while yielding
better quality of life for Medicare
beneficiaries with cancer. This survey
will provide information on how
physicians, particularly oncologists and
hematologists, adapted their practice in
response to the CMS payment incentive,
to guide future CMS demonstration
projects involving oncologists and all
specialists. Frequency: Reporting—
Once; Affected Public: Individuals or
households; Number of Respondents:
600; Total Annual Responses: 600; Total
Annual Hours: 100.
3. Type of Information Collection
Request: Extension without change of a
currently approved collection; Title of
Information Collection: Request for
Employment Information; Form
Numbers: CMS–R–297 (OMB#: 0938–
0787); Use: Section 1837(i) of the Social
Security Act provides for a special
enrollment period for individuals who
delay enrolling in Medicare Part B
because they are covered by a group
health plan based on their own or a
spouse’s current employment status.
When these individuals apply for
Medicare Part B, they must provide
proof that the group health plan
coverage is (or was) based on current
employment status. This form is used by
the Social Security Administration to
obtain information from employers
regarding whether a Medicare
beneficiary’s coverage under a group
health plan is based on current
VerDate Aug<31>2005
16:20 Jun 28, 2007
Jkt 211001
employment status. Frequency:
Reporting—Once; Affected Public:
Business or Other for profits and Notfor-profit institutions; Number of
Respondents: 5000; Total Annual
Responses: 5000; Total Annual Hours:
1250.
4. Type of Information Collection
Request: New collection; Title of
Information Collection: Medicare
Competitive Acquisition Program (CAP)
for Part B Drugs Evaluation: CAP
Physician Survey; Form Numbers:
CMS–10223 (OMB#: 0938–New); Use:
This physician survey is part of an
overall evaluation of the Centers for
Medicare and Medicaid Services
congressionally mandated Competitive
Acquisition for Part B Drugs and
Biologicals Program (CAP). Medicare
Prescription Drug Improvement and
Modernization Act (MMA) section
303(d) requires the implementation of
the CAP for those drugs and biologicals
covered by Medicare part B that are not
paid on a cost or prospective payment
system. Since July 1, 2006, physicians
have been given a choice between (1)
Buying and billing for these covered
drugs under the average sales price
(ASP) system mandated in section
303(c) of the MMA; or (2) obtaining
these drugs from vendors selected for
the CAP in a competitive bidding
process. If the physician elects to obtain
drugs from a CAP vendor, the vendor,
rather than the physician, will bill
Medicare for the drug. The CAP is
therefore a major change in the way Part
B-covered drugs and biologicals are
acquired and reimbursed for, requiring
CMS to consider many design options.
The CAP mandate includes a Report to
Congress due July 1, 2008, which will
include results from this physician
survey; Frequency: Reporting—Once;
Affected Public: Business or Other for
profits; Number of Respondents: 1560;
Total Annual Responses: 1560; Total
Annual Hours: 297.50.
5. Type of Information Collection
Request: Revision 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 (08–05), CMS–1490–S (OMB#:
0938–0999); Use: The Form CMS–1500
answers the needs of many health
insurers. It is the basic form prescribed
by CMS for the Medicare program for
claims from physicians and suppliers.
The Medicaid State Agencies,
CHAMPUS/TriCare, 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.
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Medicare carriers use the data
collected on the CMS–1500 and the
CMS–1490S to determine the proper
amount of reimbursement for Part B
medical and other health services (as
listed in section 1861(s) of the Social
Security Act) provided by physicians
and suppliers to beneficiaries. The
CMS–1500 is submitted by physicians/
suppliers for all Part B Medicare.
Serving as a common claim form, the
CMS–1500 can be used by other thirdparty payers (commercial and nonprofit
health insurers) and other Federal
programs (e.g., CHAMPUS/TriCare,
Railroad Retirement Board (RRB), and
Medicaid).
However, as the CMS–1500 displays
data items required for other third-party
payers in addition to Medicare, the form
is considered too complex for use by
beneficiaries when they file their own
claims. Therefore, the CMS–1490S
(Patient’s Request for Medicare
Payment) was explicitly developed for
easy use by beneficiaries who file their
own claims. The form can be obtained
from any Social Security office or
Medicare carrier.
Since the last submission of this
information collection request, we
discontinued form CMS–1490U which
was used by employers, unions,
employer-employee organizations that
pay physicians and suppliers for their
services to employees, group practice
prepayment plans, and health
maintenance organizations. Therefore,
this collection will no longer contain
the CMS–1490U.
In sum, the CMS–1500 and CMS–
1490S result in less paperwork burden
placed on the public. The CMS–1500
provides efficiency in office procedures
for physicians and suppliers; the CMS–
1490S provides beneficiaries with a
relatively easy form to use when filing
their claims. Without the collection of
this information, claims for
reimbursement relating to the provision
of Part B medical services/supplies
could not be acted upon. This would
result in a nationwide paralysis of the
operation of the Federal Government’s
Medicare Part B program, and major
problems for the other health plans that
use the CMS–1500, inflicting severe
physical and financial hardship on
providers/suppliers as well as
beneficiaries. Frequency: Reporting—On
occasion; Affected Public: State, Local,
or Tribal Government, Business or
other-for-profit, Not-for-profit
institutions; Number of Respondents:
1,048,243; Total Annual Responses:
970,174,260; Total Annual Hours:
33,067,757.
To obtain copies of the supporting
statement and any related forms for the
E:\FR\FM\29JNN1.SGM
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Federal Register / Vol. 72, No. 125 / Friday, June 29, 2007 / Notices
proposed paperwork collections
referenced above, access CMS Web site
address at https://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.
Written comments and
recommendations for the proposed
information collections must be mailed
or faxed within 30 days of this notice
directly to the OMB desk officer: OMB
Human Resources and Housing Branch,
Attention: Carolyn Lovett, New
Executive Office Building, Room 10235,
Washington, DC 20503, Fax Number:
(202) 395–6974.
Dated: June 21, 2007.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. E7–12655 Filed 6–28–07; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HOMELAND
SECURITY
U.S. Citizenship and Immigration
Services
Agency Information Collection
Activities: Extension of a Currently
Approved Information Collection;
Request for Comments and
Suggestions for Making the Form More
User Friendly
60-Day Notice of Information
Collection Under Review: Form I–589,
Application for Asylum and
Withholding of Removal; OMB Control
No. 1615–0067.
mstockstill on PROD1PC66 with NOTICES
ACTION:
The Department of Homeland
Security, U.S. Citizenship and
Immigration Services (USCIS) has
submitted the following information
collection request for review and
clearance in accordance with the
Paperwork Reduction Act of 1995. The
information collection is published to
obtain comments from the public and
affected agencies. Comments are
encouraged and will be accepted for
sixty days until August 28, 2007.
Written comments and/or suggestions
regarding the item(s) contained in this
notice, especially regarding the
estimated public burden and associated
response time, should be directed to the
Department of Homeland Security
(DHS), USCIS, Chief, Regulatory
Management Division, Clearance Office,
111 Massachusetts Avenue, 4th floor,
VerDate Aug<31>2005
16:20 Jun 28, 2007
Jkt 211001
Washington, DC 20529. Comments may
also be submitted to DHS via facsimile
to 202–272–8352 or via e-mail at
rfs.regs@dhs.gov. When submitting
comments by e-mail please make sure to
add OMB Control Number 1615–0067 in
the subject box. Comments received
from the public will also be provided to
the Department of Justice, Executive
Office for Immigration Review, for
review and response as part of this
information collection request. Written
comments and suggestions from the
public and affected agencies should
address one or more of the following
five points:
(1) Evaluate whether the proposed
collection of information is necessary
for the proper performance of the
functions of the agency, including
whether the information will have
practical utility;
(2) Evaluate the accuracy of the
agencies estimate of the burden of the
proposed collection of information,
including the validity of the
methodology and assumptions used;
(3) Enhance the quality, utility, and
clarity of the information to be
collected;
(4) Minimize the burden of the
collection of information on those who
are to respond, including through the
use of appropriate automated,
electronic, mechanical, or other
technological collection techniques or
other forms of information technology,
e.g., permitting electronic submission of
responses; and
(5) Suggest how the collection of
information can be made more
customer-friendly, identify any
confusing and/or unnecessary language
contained in the collection of
information (including the form and
form instructions), and offer specific
ways that the form and form
instructions can be improved upon or
clarified so that they are more easily
understood by those who do not speak
English as their primary language and
who may not be familiar with legal
terms. Any suggested changes in
language must be consistent with the
statutory, regulatory and legal
requirements for asylum, withholding of
removal, and protection pursuant to the
Convention Against Torture, and must
be sufficiently precise so as to elicit the
information needed by adjudicators to
decide the cases before them and to
provide adequate notice to the applicant
of the legal consequences and
requirements associated with the
application.
Overview of this information
collection:
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35713
(1) Type of Information Collection:
Extension of a currently approved
information collection.
(2) Title of the Form/Collection:
Application for Asylum and for
Withholding of Removal.
(3) Agency form number, if any, and
the applicable component of the
Department of Homeland Security
sponsoring the collection: Form I–589.
U.S. Citizenship and Immigration
Services.
(4) Affected public who will be asked
or required to respond, as well as a brief
abstract: Primary: Individuals or
Households. This information collection
will be used to determine whether an
alien applying for asylum and/or
withholding of deportation in the
United States is classifiable as a refugee,
and is eligible to remain in the United
States.
(5) An estimate of the total number of
respondents and the amount of time
estimated for an average respondent to
respond: 63,138 responses at 12 hours
per response.
(6) An estimate of the total public
burden (in hours) associated with the
collection: 757,656 annual burden
hours.
If you have additional comments,
suggestions, or need a copy of the
proposed information collection
instrument with instructions, or
additional information, please visit the
USCIS Web site at: https://
www.uscis.gov/portal/site/uscis/
menuitem.eb1d4c2a3e5b9ac89243c
6a7543f6d1a/?vgnextoid=29227b58f
a16e010VgnV
CM1000000ecd190aRCRD&vgnextc
hannel=29227b58fa16e010VgnVCM
1000000ecd190aRCRD.
If additional information is required
contact: USCIS, Regulatory Management
Division, 111 Massachusetts Avenue,
3rd Floor, Washington, DC 20529, (202)
272–8377.
Dated: June 25, 2007.
Richard A. Sloan,
Chief, Regulatory Management Division, U.S.
Citizenship and Immigration Services,
Department of Homeland Security.
[FR Doc. E7–12630 Filed 6–28–07; 8:45 am]
BILLING CODE 4410–10–P
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Agencies
[Federal Register Volume 72, Number 125 (Friday, June 29, 2007)]
[Notices]
[Pages 35711-35713]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E7-12655]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-R-26, CMS-10217, CMS-R-297, CMS-10223, and
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 without change
of a currently approved collection; Title of Information Collection:
Information Collection Requirements (ICRs) 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, 439.1253,
493.1254, 493.1255, 493.1256, 493.1261, 493.1262, 493.1263, 493.1269,
493.1273, 493.1274, 493.1278, 493.1283, 493.12889, 493.1291, and
493.1299; Form Numbers: CMS-R-26 (OMB: 0938-0612); Use: The
ICRs referenced in 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 standards) in order to be certified by the
Department of Health and Human Services (HHS). HHS conducts inspections
to determine a laboratory's compliance with CLIA requirements. CLIA
implements the certificate, laboratory standards and inspection
[[Page 35712]]
requirements; Frequency: Reporting--As needed; Affected Public: State,
Local or Tribal Governments, Federal Government, Business or Other for
profits and Not-for-profit institutions; Number of Respondents:
168,688; Total Annual Responses: 756,241; Total Annual Hours:
11,363,680.
2. Type of Information Collection Request: New collection; Title of
Information Collection: Physician Survey for the 2006 Medicare Oncology
Demonstration Program; Form Numbers: CMS-10217 (OMB: 0938-
New); Use: The 2006 Oncology Demonstration Program aimed to: (1) Have
oncology payments increasingly focused on patient-centered care, rather
than chemotherapy administration; (2) learn to what extent Medicare
beneficiaries are being treated in a manner that yields the best
outcomes; (3) understand clinical cancer scenarios where there is not
clinical consensus among physicians on the relevance of specific
evidence-based practice guidelines; and, (4) ensure that due emphasis
is placed on multi-disciplinary, comprehensive approach to palliation
and end of life care. In addition, CMS hoped to reduce the potential
that unnecessary services and tests are being performed, thereby
lowering program costs while yielding better quality of life for
Medicare beneficiaries with cancer. This survey will provide
information on how physicians, particularly oncologists and
hematologists, adapted their practice in response to the CMS payment
incentive, to guide future CMS demonstration projects involving
oncologists and all specialists. Frequency: Reporting--Once; Affected
Public: Individuals or households; Number of Respondents: 600; Total
Annual Responses: 600; Total Annual Hours: 100.
3. Type of Information Collection Request: Extension without change
of a currently approved collection; Title of Information Collection:
Request for Employment Information; Form Numbers: CMS-R-297
(OMB: 0938-0787); Use: Section 1837(i) of the Social Security
Act provides for a special enrollment period for individuals who delay
enrolling in Medicare Part B because they are covered by a group health
plan based on their own or a spouse's current employment status. When
these individuals apply for Medicare Part B, they must provide proof
that the group health plan coverage is (or was) based on current
employment status. This form is used by the Social Security
Administration to obtain information from employers regarding whether a
Medicare beneficiary's coverage under a group health plan is based on
current employment status. Frequency: Reporting--Once; Affected Public:
Business or Other for profits and Not-for-profit institutions; Number
of Respondents: 5000; Total Annual Responses: 5000; Total Annual Hours:
1250.
4. Type of Information Collection Request: New collection; Title of
Information Collection: Medicare Competitive Acquisition Program (CAP)
for Part B Drugs Evaluation: CAP Physician Survey; Form Numbers: CMS-
10223 (OMB: 0938-New); Use: This physician survey is part of
an overall evaluation of the Centers for Medicare and Medicaid Services
congressionally mandated Competitive Acquisition for Part B Drugs and
Biologicals Program (CAP). Medicare Prescription Drug Improvement and
Modernization Act (MMA) section 303(d) requires the implementation of
the CAP for those drugs and biologicals covered by Medicare part B that
are not paid on a cost or prospective payment system. Since July 1,
2006, physicians have been given a choice between (1) Buying and
billing for these covered drugs under the average sales price (ASP)
system mandated in section 303(c) of the MMA; or (2) obtaining these
drugs from vendors selected for the CAP in a competitive bidding
process. If the physician elects to obtain drugs from a CAP vendor, the
vendor, rather than the physician, will bill Medicare for the drug. The
CAP is therefore a major change in the way Part B-covered drugs and
biologicals are acquired and reimbursed for, requiring CMS to consider
many design options. The CAP mandate includes a Report to Congress due
July 1, 2008, which will include results from this physician survey;
Frequency: Reporting--Once; Affected Public: Business or Other for
profits; Number of Respondents: 1560; Total Annual Responses: 1560;
Total Annual Hours: 297.50.
5. Type of Information Collection Request: Revision 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 (08-05), CMS-1490-S (OMB:
0938-0999); Use: The Form CMS-1500 answers the needs of many health
insurers. It is the basic form prescribed by CMS for the Medicare
program for claims from physicians and suppliers. The Medicaid State
Agencies, CHAMPUS/TriCare, 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.
Medicare carriers use the data collected on the CMS-1500 and the
CMS-1490S to determine the proper amount of reimbursement for Part B
medical and other health services (as listed in section 1861(s) of the
Social Security Act) provided by physicians and suppliers to
beneficiaries. The CMS-1500 is submitted by physicians/suppliers for
all Part B Medicare. Serving as a common claim form, the CMS-1500 can
be used by other third-party payers (commercial and nonprofit health
insurers) and other Federal programs (e.g., CHAMPUS/TriCare, Railroad
Retirement Board (RRB), and Medicaid).
However, as the CMS-1500 displays data items required for other
third-party payers in addition to Medicare, the form is considered too
complex for use by beneficiaries when they file their own claims.
Therefore, the CMS-1490S (Patient's Request for Medicare Payment) was
explicitly developed for easy use by beneficiaries who file their own
claims. The form can be obtained from any Social Security office or
Medicare carrier.
Since the last submission of this information collection request,
we discontinued form CMS-1490U which was used by employers, unions,
employer-employee organizations that pay physicians and suppliers for
their services to employees, group practice prepayment plans, and
health maintenance organizations. Therefore, this collection will no
longer contain the CMS-1490U.
In sum, the CMS-1500 and CMS-1490S result in less paperwork burden
placed on the public. The CMS-1500 provides efficiency in office
procedures for physicians and suppliers; the CMS-1490S provides
beneficiaries with a relatively easy form to use when filing their
claims. Without the collection of this information, claims for
reimbursement relating to the provision of Part B medical services/
supplies could not be acted upon. This would result in a nationwide
paralysis of the operation of the Federal Government's Medicare Part B
program, and major problems for the other health plans that use the
CMS-1500, inflicting severe physical and financial hardship on
providers/suppliers as well as beneficiaries. Frequency: Reporting--On
occasion; Affected Public: State, Local, or Tribal Government, Business
or other-for-profit, Not-for-profit institutions; Number of
Respondents: 1,048,243; Total Annual Responses: 970,174,260; Total
Annual Hours: 33,067,757.
To obtain copies of the supporting statement and any related forms
for the
[[Page 35713]]
proposed paperwork collections referenced above, access CMS Web site
address at https://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.
Written comments and recommendations for the proposed information
collections must be mailed or faxed within 30 days of this notice
directly to the OMB desk officer: OMB Human Resources and Housing
Branch, Attention: Carolyn Lovett, New Executive Office Building, Room
10235, Washington, DC 20503, Fax Number: (202) 395-6974.
Dated: June 21, 2007.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. E7-12655 Filed 6-28-07; 8:45 am]
BILLING CODE 4120-01-P