Agency Information Collection Activities: Proposed Collection; Comment Request, 47954-47955 [E8-18958]
Download as PDF
<![CDATA[
47954
Federal Register / Vol. 73, No. 159 / Friday, August 15, 2008 / Notices
Business or other for-profits, and
Individual and households; Number of
Respondents: 6,400; Total Annual
Responses: 6,400; Total Annual Hours:
1,472.
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/
PaperworkReductionActof1995, or Email 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 September 15, 2008. OMB Human
Resources and Housing Branch,
Attention: OMB Desk Officer, New
Executive Office Building, Room 10235,
Washington, DC 20503, Fax Number:
(202) 395–6974.
Dated: August 7, 2008.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. E8–18957 Filed 8–14–08; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–4040 and
4040SP, CMS–R–10, CMS–10130A and
10130B, and CMS–R–257]
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;
(2) the accuracy of the estimated
burden; (3) ways to enhance the quality,
mstockstill on PROD1PC66 with NOTICES
AGENCY:
VerDate Aug<31>2005
19:03 Aug 14, 2008
Jkt 214001
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
Enrollment in Supplementary Medical
Insurance; Use: Section 1836 of the
Social Security Act and 42 CFR 407.10
provide the eligibility requirements for
enrollment in Supplementary Medical
Insurance (Part B) for individuals age 65
and older who are not entitled to
premium-free Hospital Insurance (Part
A). The form CMS–4040 is used to
establish entitlement to Part B by
individuals ineligible for Part A under
Title XVIII of the Social Security Act.
Form Number: CMS–4040 and 4040SP
(OMB# 0938–0245); Frequency: Once;
Affected Public: Individuals and
households; Number of Respondents:
10,000; Total Annual Responses:
10,000; Total Annual Hours: 2,500.
2. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: BPD–718:
Advance Directives (Medicare and
Medicaid); Use: Steps have been taken
at both the Federal and State level to
afford greater opportunity for the
individual to participate in decisions
made concerning the medical treatment
to be received by an adult patient in the
event that the patient is unable to
communicate to others a preference
about medical treatment. The individual
may make his preference known
through the use of an advance directive,
which is a written instruction prepared
in advance, such as a living will or
durable power of attorney. This
information is documented in a
prominent part of the individual’s
medical record. Advance directives as
described in the Patient SelfDetermination Act have increased the
individual’s control over decisions
concerning medical treatment. The
advance directives requirement was
enacted because Congress wanted
individuals to know that they have a
right to make health care decisions and
to refuse treatment even when they are
unable to communicate. Sections 4206
of OBRA ’90 defined an advance
directive as a written instruction
recognized under State law relating to
the provision of health care when an
individual is incapacitated (those
persons unable to communicate their
wishes regarding medical treatment).
All states have enacted legislation
defining a patient’s right to make
PO 00000
Frm 00079
Fmt 4703
Sfmt 4703
decisions regarding medical care,
including the right to accept or refuse
medical or surgical treatment and the
right to formulate advance directives.
Participating hospitals, skilled nursing
facilities/nursing facilities, home health
agencies, providers of home health care,
hospices, religious nonmedical health
care institutions, and prepaid or eligible
organizations (including Health Care
Prepayment Plans (HCPPs) and
Medicare Advantage Organizations
(MAOs) such as Coordinated Care Plans,
Demonstration Projects, Chronic Care
Demonstration Projects, Program of All
Inclusive Care for the Elderly, Private
Fee for Service, and Medical Savings
Accounts must provide written
information, at explicit time frames, to
all adult individuals about: (a) The right
to accept or refuse medical or surgical
treatments; (b) the right to formulate an
advance directive; (c) a description of
applicable State law (provided by the
State); and (d) the provider’s or
organization’s policies and procedures
for implementing an advance directive.
Form Number: CMS–R–10 (OMB#
0938–0610); Frequency: Yearly; Affected
Public: Business or other for-profits;
Number of Respondents: 35,484; Total
Annual Responses: 19,870,000; Total
Annual Hours: 927,550.
3. Type of Information Collection
Request: Extension of a currently
approved collection; Title of
Information Collection: Federal
Reimbursement of Emergency Health
Services Furnished to Undocumented
Aliens, Section 1011 of the Medicare
Prescription Drug, Improvement and
Modernization Act of 2003 (MMA):
‘‘Section 1011 Provider Payment
Determination’’ and ‘‘Request for
Section 1011 Hospital On-Call Payments
to Physicians’’ Forms; Use: Section 1011
of the MMA requires that the Secretary
establish a process under which eligible
providers (certain hospitals, physicians
and ambulance providers) may request
payment for (claim) their otherwise unreimbursed costs of providing eligible
services. The Secretary must make
quarterly payments directly to such
providers. The Secretary must also
implement measures to ensure that
inappropriate, excessive, or fraudulent
payments are not made under Section
1011, including certification by
providers of the accuracy of their
requests for payment. The Section 1011
Provider Payment Determination and
the Request for Section 1011 Hospital
On-Call Payments to Physicians forms
have been established to address the
statutory requirements. Form Number:
CMS–10130A and 10130B (OMB# 0938–
0952); Frequency: Daily, Weekly,
E:\FR\FM\15AUN1.SGM
15AUN1
47955
Federal Register / Vol. 73, No. 159 / Friday, August 15, 2008 / Notices
Monthly, Quarterly and Yearly; Affected
Public: Business or Other For-Profits
and Not-for-Profit Institutions; Number
of Respondents: 12,037; Total Annual
Responses: 300,148; Total Annual
Hours: 75,007.
4. Type of Information Collection
Request: Revision of a currently
approved collection; Title of
Information Collection: Medicare
Advantage & Part D Disenrollment
Requests Collected Through 1–800–
MEDICARE; Use: Section 4001 of the
Balanced Budget Act of 1997 amended
the Social Security Act to add Section
1851(c)(1), through which Medicare
Advantage elections are made and
changed. Section 101 of the Medicare
Prescription Drug, Improvement, and
Modernization Act amended the Social
Security Act to include section 1860D–
1(b)(1), through which Medicare
Prescription Drug Plan enrollments are
made and changed. The disenrollment
process offered at 1–800–MEDICARE
provides beneficiaries with the option of
submitting a disenrollment request to a
neutral third party, who then processes
the disenrollment action as a change of
enrollment.
The collection updates: 1. Continue to
allow Medicare beneficiaries to
disenroll from Medicare Advantage
plans by calling CMS’ toll-free call
center; 2. Continue to allow Medicare
beneficiaries enrolled in Medicare
Prescription Drug (Part D) Plans to
request disenrollment from Medicare
Prescription Drug Plans, and 3. Retire
the CMS–R–257 Medicare Advantage
Disenrollment Form given limited (zero)
requests for the paper form since 2005.
The information collected in the
disenrollment process will be used to
update the Medicare beneficiary’s
Health Insurance Master Record System
in order to disenroll the beneficiary
from a Medicare Advantage managed
care plan or a Medicare prescription
drug plan on a timely basis. Form
Number: CMS–R–257 (OMB# 0938–
0741); Frequency: Occasionally;
Affected Public: Individuals or
households; Number of Respondents:
117,000; Total Annual Responses:
117,000; Total Annual Hours: 19,539.
To obtain copies of the supporting
statement and any related forms for the
proposed paperwork collections
referenced above, access CMS’ Web Site
at https://www.cms.hhs.gov/
PaperworkReductionActof1995, or email 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.
In commenting on the proposed
information collections please reference
the document identifier or OMB control
number. To be assured consideration,
comments and recommendations must
be submitted in one of the following
ways by October 14, 2008:
1. Electronically. You may submit
your comments electronically to https://
www.regulations.gov. Follow the
instructions for ‘‘Comment or
Submission’’ or ‘‘More Search Options’’
to find the information collection
document(s) accepting comments.
2. By regular mail. You may mail
written comments to the following
address: CMS, Office of Strategic
Operations and Regulatory Affairs,
Division of Regulations Development,
Attention: Document Identifier/OMB
Control Number, Room C4–26–05, 7500
Security Boulevard, Baltimore,
Maryland 21244–1850.
Dated: August 7, 2008.
Michelle Shortt,
Director, Regulations Development Group,
Office of Strategic Operations and Regulatory
Affairs.
[FR Doc. E8–18958 Filed 8–14–08; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Submission for OMB Review;
Comment Request
Title: Evaluation of the Improving
Child Welfare Outcome through
Systems of Care Grant Program.
OMB No.: 0970–0288.
Description: The 1994 Amendments
to the Social Security Act (SSA)
authorize the U.S. Department of Health
and Human Services to review State
child and family service programs to
ensure conformance with the
requirements in titles IV–B and IV–E of
SSA. Under the Final Rule, which took
effect March 25, 2000, States are
assessed for substantial conformity with
certain Federal requirements for childwelfare services. The Child and Family
Service Reviews (CFSR), administered
by the Children’s Bureau, are designed
to ensure conformity with Federal childwelfare requirements and, ultimately, to
help States improve child welfare
services and outcomes, specifically
safety, permanency and well-being
outcomes for child-welfare-involved
children and their families. States
determined not to have achieved
substantial conformity in any of the
areas assessed are required to develop
and implement Program Improvement
Plans (PIP) addressing the areas of
nonconformity.
The Systems of Care grant cluster,
from which these data are proposed to
be collected, is designed to encourage
public child-welfare agencies to address
the issues identified in their State’s
CPSR. The data collected from these
demonstration sites will allow the
Children’s Bureau to test whether this
approach can help States reach the goals
stated in their PIP and explore how
child-welfare can benefit from being
part of a system of care. Data will be
collected via interviews, forms
completed by project staff, surveys,
focus groups and case-file reviews. Data
also will be collected to determine the
extent to which the Technical
Assistance (TA) provided, brokered or
contracted by the TA and Evaluation
Center is meeting the needs of the
grantees, and how.
Respondents: Systems of Care Project
Directors (members of the Systems of
Care collaborative may include
representatives from mental health,
juvenile justice, education, health,
among others); child-welfare agency
supervisors and caseworkers; partner
agency caseworkers; and families who
have been involved with the childwelfare system.
ANNUAL BURDEN ESTIMATES
Number of
respondents
mstockstill on PROD1PC66 with NOTICES
Instrument
Affected public
Stakeholder Survey ...........................
Individuals/Households ....................
Private Sector ..................................
State/Local/Tribal .............................
State/Local/Tribal .............................
State/Local/Tribal .............................
Child-Welfare Agency Survey ...........
Supervisor Interviews ........................
VerDate Aug<31>2005
19:03 Aug 14, 2008
Jkt 214001
PO 00000
Frm 00080
Fmt 4703
Sfmt 4703
Number of
responses per
respondent
20
60
190
600
90
E:\FR\FM\15AUN1.SGM
1
1
1
1
1
15AUN1
Average
burden hours
per response
.5
.5
.5
1
1
Total burden
hours
10
30
95
600
90
]]>Agencies
[Federal Register Volume 73, Number 159 (Friday, August 15, 2008)]
[Notices]
[Pages 47954-47955]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-18958]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-4040 and 4040SP, CMS-R-10, CMS-10130A and
10130B, and CMS-R-257]
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: Request for
Enrollment in Supplementary Medical Insurance; Use: Section 1836 of the
Social Security Act and 42 CFR 407.10 provide the eligibility
requirements for enrollment in Supplementary Medical Insurance (Part B)
for individuals age 65 and older who are not entitled to premium-free
Hospital Insurance (Part A). The form CMS-4040 is used to establish
entitlement to Part B by individuals ineligible for Part A under Title
XVIII of the Social Security Act. Form Number: CMS-4040 and 4040SP
(OMB 0938-0245); Frequency: Once; Affected Public: Individuals
and households; Number of Respondents: 10,000; Total Annual Responses:
10,000; Total Annual Hours: 2,500.
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: BPD-718: Advance
Directives (Medicare and Medicaid); Use: Steps have been taken at both
the Federal and State level to afford greater opportunity for the
individual to participate in decisions made concerning the medical
treatment to be received by an adult patient in the event that the
patient is unable to communicate to others a preference about medical
treatment. The individual may make his preference known through the use
of an advance directive, which is a written instruction prepared in
advance, such as a living will or durable power of attorney. This
information is documented in a prominent part of the individual's
medical record. Advance directives as described in the Patient Self-
Determination Act have increased the individual's control over
decisions concerning medical treatment. The advance directives
requirement was enacted because Congress wanted individuals to know
that they have a right to make health care decisions and to refuse
treatment even when they are unable to communicate. Sections 4206 of
OBRA '90 defined an advance directive as a written instruction
recognized under State law relating to the provision of health care
when an individual is incapacitated (those persons unable to
communicate their wishes regarding medical treatment).
All states have enacted legislation defining a patient's right to
make decisions regarding medical care, including the right to accept or
refuse medical or surgical treatment and the right to formulate advance
directives. Participating hospitals, skilled nursing facilities/nursing
facilities, home health agencies, providers of home health care,
hospices, religious nonmedical health care institutions, and prepaid or
eligible organizations (including Health Care Prepayment Plans (HCPPs)
and Medicare Advantage Organizations (MAOs) such as Coordinated Care
Plans, Demonstration Projects, Chronic Care Demonstration Projects,
Program of All Inclusive Care for the Elderly, Private Fee for Service,
and Medical Savings Accounts must provide written information, at
explicit time frames, to all adult individuals about: (a) The right to
accept or refuse medical or surgical treatments; (b) the right to
formulate an advance directive; (c) a description of applicable State
law (provided by the State); and (d) the provider's or organization's
policies and procedures for implementing an advance directive. Form
Number: CMS-R-10 (OMB 0938-0610); Frequency: Yearly; Affected
Public: Business or other for-profits; Number of Respondents: 35,484;
Total Annual Responses: 19,870,000; Total Annual Hours: 927,550.
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Federal
Reimbursement of Emergency Health Services Furnished to Undocumented
Aliens, Section 1011 of the Medicare Prescription Drug, Improvement and
Modernization Act of 2003 (MMA): ``Section 1011 Provider Payment
Determination'' and ``Request for Section 1011 Hospital On-Call
Payments to Physicians'' Forms; Use: Section 1011 of the MMA requires
that the Secretary establish a process under which eligible providers
(certain hospitals, physicians and ambulance providers) may request
payment for (claim) their otherwise un-reimbursed costs of providing
eligible services. The Secretary must make quarterly payments directly
to such providers. The Secretary must also implement measures to ensure
that inappropriate, excessive, or fraudulent payments are not made
under Section 1011, including certification by providers of the
accuracy of their requests for payment. The Section 1011 Provider
Payment Determination and the Request for Section 1011 Hospital On-Call
Payments to Physicians forms have been established to address the
statutory requirements. Form Number: CMS-10130A and 10130B
(OMB 0938-0952); Frequency: Daily, Weekly,
[[Page 47955]]
Monthly, Quarterly and Yearly; Affected Public: Business or Other For-
Profits and Not-for-Profit Institutions; Number of Respondents: 12,037;
Total Annual Responses: 300,148; Total Annual Hours: 75,007.
4. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Medicare
Advantage & Part D Disenrollment Requests Collected Through 1-800-
MEDICARE; Use: Section 4001 of the Balanced Budget Act of 1997 amended
the Social Security Act to add Section 1851(c)(1), through which
Medicare Advantage elections are made and changed. Section 101 of the
Medicare Prescription Drug, Improvement, and Modernization Act amended
the Social Security Act to include section 1860D-1(b)(1), through which
Medicare Prescription Drug Plan enrollments are made and changed. The
disenrollment process offered at 1-800-MEDICARE provides beneficiaries
with the option of submitting a disenrollment request to a neutral
third party, who then processes the disenrollment action as a change of
enrollment.
The collection updates: 1. Continue to allow Medicare beneficiaries
to disenroll from Medicare Advantage plans by calling CMS' toll-free
call center; 2. Continue to allow Medicare beneficiaries enrolled in
Medicare Prescription Drug (Part D) Plans to request disenrollment from
Medicare Prescription Drug Plans, and 3. Retire the CMS-R-257 Medicare
Advantage Disenrollment Form given limited (zero) requests for the
paper form since 2005. The information collected in the disenrollment
process will be used to update the Medicare beneficiary's Health
Insurance Master Record System in order to disenroll the beneficiary
from a Medicare Advantage managed care plan or a Medicare prescription
drug plan on a timely basis. Form Number: CMS-R-257 (OMB 0938-
0741); Frequency: Occasionally; Affected Public: Individuals or
households; Number of Respondents: 117,000; Total Annual Responses:
117,000; Total Annual Hours: 19,539.
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, access CMS'
Web Site 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.
In commenting on the proposed information collections please
reference the document identifier or OMB control number. To be assured
consideration, comments and recommendations must be submitted in one of
the following ways by October 14, 2008:
1. Electronically. You may submit your comments electronically to
https://www.regulations.gov. Follow the instructions for ``Comment or
Submission'' or ``More Search Options'' to find the information
collection document(s) accepting comments.
2. By regular mail. You may mail written comments to the following
address: CMS, Office of Strategic Operations and Regulatory Affairs,
Division of Regulations Development, Attention: Document Identifier/OMB
Control Number, Room C4-26-05, 7500 Security Boulevard, Baltimore,
Maryland 21244-1850.
Dated: August 7, 2008.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations
and Regulatory Affairs.
[FR Doc. E8-18958 Filed 8-14-08; 8:45 am]
BILLING CODE 4120-01-P
