Agency Information Collection Activities: Proposed Collection; Comment Request, 31615-31616 [2012-12810]

Download as PDF srobinson on DSK4SPTVN1PROD with NOTICES Federal Register / Vol. 77, No. 103 / Tuesday, May 29, 2012 / Notices Web site, at https://www.ftc.gov/os/ publiccomments.shtm. As a matter of discretion, the Commission tries to remove individuals’ home contact information from comments before placing them on the Commission Web site. Because your comment will be made public, you are solely responsible for making sure that your comment does not include any sensitive personal information, like anyone’s Social Security number, date of birth, driver’s license number or other state identification number or foreign country equivalent, passport number, financial account number, or credit or debit card number. You are also solely responsible for making sure that your comment does not include any sensitive health information, like medical records or other individually identifiable health information. In addition, do not include any ‘‘[t]rade secret or any commercial or financial information which is obtained from any person and which is privileged or confidential’’ as provided in Section 6(f) of the FTC Act, 15 U.S.C. 46(f), and FTC Rule 4.10(a)(2), 16 CFR 4.10(a)(2). In particular, do not include competitively sensitive information such as costs, sales statistics, inventories, formulas, patterns, devices, manufacturing processes, or customer names. If you want the Commission to give your comment confidential treatment, you must file it in paper form, with a request for confidential treatment, and you have to follow the procedure explained in FTC Rule 4.9(c).13 Your comment will be kept confidential only if the FTC General Counsel, in his or her sole discretion, grants your request in accordance with the law and the public interest. Postal mail addressed to the Commission is subject to delay due to heightened security screening. As a result, we encourage you to submit your comments online. To make sure that the Commission considers your online comment, you must file it at https:// ftcpublic.commentworks.com/ftc/ healthbreachnotificationPRA, by following the instructions on the webbased form. If this Notice appears at https://www.regulations.gov/#!home, you also may file a comment through that Web site. If you file your comment on paper, write ‘‘Health Breach Notification Rule, PRA comments, P–125402’’ on your 13 In particular, the written request for confidential treatment that accompanies the comment must include the factual and legal basis for the request, and must identify the specific portions of the comment to be withheld from the public record. See FTC Rule 4.9(c), 16 CFR 4.9(c). VerDate Mar<15>2010 16:12 May 25, 2012 Jkt 226001 comment and on the envelope, and mail or deliver it to the following address: Federal Trade Commission, Office of the Secretary, Room H–113 (Annex J), 600 Pennsylvania Avenue NW., Washington, DC 20580. If possible, submit your paper comment to the Commission by courier or overnight service. Visit the Commission Web site at to read this Notice and the news release describing it. The FTC Act and other laws that the Commission administers permit the collection of public comments to consider and use in this proceeding as appropriate. The Commission will consider all timely and responsive public comments that it receives on or before July 30, 2012. You can find more information, including routine uses permitted by the Privacy Act, in the Commission’s privacy policy, at https://www.ftc.gov/ftc/ privacy.htm. Christian S. White, Acting General Counsel. [FR Doc. 2012–12863 Filed 5–25–12; 8:45 am] 31615 practices, remain in compliance with Executive Orders and the Federal Management Regulation, Federal agencies, internal policies should address the four requirements described in this bulletin. These include: (1) Consolidation of mail including presorting; (2) reductions of hard copy agency-to-agency mailings; (3) sustainable mail practices; and (4) secure mail for teleworkers. Dated: May 16, 2012. Carolyn Austin Diggs, Assistant Deputy Associate Administrator, Office of Asset and Transportation Management, Office of Governmentwide Policy. [FR Doc. 2012–12985 Filed 5–25–12; 8:45 am] BILLING CODE 6860–14–P DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services BILLING CODE 6750–01–P [Document Identifier CMS–1500 (08/05) and CMS–1500 (2/12)] GENERAL SERVICES ADMINISTRATION Agency Information Collection Activities: Proposed Collection; Comment Request [Notice–FMR–2012–G–03; Docket No. 2012– 0004, Sequence 3] AGENCY: Improving Mail Management Policies, Procedures, and Activities Office of Governmentwide Policy, General Services Administration (GSA). ACTION: Notice of FMR Bulletin G–03. AGENCY: The General Services Administration (GSA) has issued Federal Management Regulation (FMR) Bulletin G–03 which provides guidance to Executive Branch agencies for improving mail management policies, procedures, and activities. FMR Bulletin G–03 and all other FMR Bulletins may be found at https://www.gsa.gov/portal/ content/102955#MailManagement. DATES: Effective Date: This notice is effective May 29, 2012. Applicability Date: This notice applies to Mail Management Policy performed on or after May 2, 2012. FOR FURTHER INFORMATION CONTACT: Mr. Derrick Miliner, Office of Governmentwide Policy (MAF), Office of Asset and Transportation Management, General Services Administration at (202) 273–3564 or via email at derrick.miliner@gsa.gov. Please cite FMR Bulletin G–03. SUPPLEMENTARY INFORMATION: In an effort to cut waste, increase sustainable SUMMARY: PO 00000 Frm 00052 Fmt 4703 Sfmt 4703 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: Reinstatement without change of a previously approved collection; Title of Information Collection: Health Insurance Common Claims Form and Supporting Regulations at 42 CFR part 424, Subpart C; 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 E:\FR\FM\29MYN1.SGM 29MYN1 srobinson on DSK4SPTVN1PROD with NOTICES 31616 Federal Register / Vol. 77, No. 103 / Tuesday, May 29, 2012 / Notices 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 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. Form Number: CMS– 1500(08/05), CMS–1490–S (OMB#: 0938–0999); Frequency: Reporting—On occasion; Affected Public: State, Local, or Tribal Government, Business or other-for-profit, Not-for-profit institutions; Number of Respondents: 1,448,346; Total Annual Responses: 988,005,045; Total Annual Hours: 21,418,336. (For policy questions regarding this collection contact Brian Reitz at 410–786–5001. For all other issues call 410–786–1326.) 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; 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 VerDate Mar<15>2010 17:01 May 25, 2012 Jkt 226001 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. Most recently, the National Uniform Claim Committee (NUCC) has revised the CMS–1500. The NUCC began revision work on the 1500 Claim Form, version 02/12 in 2009. The goal of this work was to align the paper form with some of the changes in the electronic Health Care Claim: Professional (837), 005010X222 Technical Report Type 3 (5010) and 005010X222A1 Technical Report Type 3 (5010A1). During the revision work, consideration was given to different approaches to revising the form. The NUCC decided to proceed with making ‘‘minor changes’’ to the current form, which was defined as no physical changes to the existing form lines or underlying layout of the form. Once the CMS–1500 (02/12) has been approved, the CMS–1500 (08/05) will be discontinued after a form runoff period during which both the CMS–1500 (08/ 05) and the CMS–1500 (02/12) can be used. Form Number: CMS–1500(02/12), CMS–1490–S (OMB#: 0938–New); Frequency: Reporting—On occasion; Affected Public: State, Local, or Tribal Government, Business or other-forprofit, Not-for-profit institutions; Number of Respondents: 1,448,346; Total Annual Responses: 988,005,045; Total Annual Hours: 21,418,336. (For policy questions regarding this collection contact Brian Reitz at 410– 786–5001. For all other issues call 410– 786–1326.) 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 PO 00000 Frm 00053 Fmt 4703 Sfmt 4703 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 July 30, 2012: 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 llll, Room C4–26– 05, 7500 Security Boulevard, Baltimore, Maryland 21244–1850. Dated: May 22, 2012. Martique Jones, Director, Regulations Development Group, Division B, Office of Strategic Operations and Regulatory Affairs. [FR Doc. 2012–12810 Filed 5–25–12; 8:45 am] BILLING CODE 4120–01–P DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [Document Identifier CMS–10426, CMS– 10421 and CMS–10415] 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 AGENCY: E:\FR\FM\29MYN1.SGM 29MYN1

Agencies

[Federal Register Volume 77, Number 103 (Tuesday, May 29, 2012)]
[Notices]
[Pages 31615-31616]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-12810]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier CMS-1500 (08/05) and CMS-1500 (2/12)]


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: Reinstatement without 
change of a previously approved collection; Title of Information 
Collection: Health Insurance Common Claims Form and Supporting 
Regulations at 42 CFR part 424, Subpart C; 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

[[Page 31616]]

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. Form Number: CMS-1500(08/05), CMS-1490-S 
(OMB: 0938-0999); Frequency: Reporting--On occasion; Affected 
Public: State, Local, or Tribal Government, Business or other-for-
profit, Not-for-profit institutions; Number of Respondents: 1,448,346; 
Total Annual Responses: 988,005,045; Total Annual Hours: 21,418,336. 
(For policy questions regarding this collection contact Brian Reitz at 
410-786-5001. For all other issues call 410-786-1326.)
    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; 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.
    Most recently, the National Uniform Claim Committee (NUCC) has 
revised the CMS-1500. The NUCC began revision work on the 1500 Claim 
Form, version 02/12 in 2009. The goal of this work was to align the 
paper form with some of the changes in the electronic Health Care 
Claim: Professional (837), 005010X222 Technical Report Type 3 (5010) 
and 005010X222A1 Technical Report Type 3 (5010A1). During the revision 
work, consideration was given to different approaches to revising the 
form. The NUCC decided to proceed with making ``minor changes'' to the 
current form, which was defined as no physical changes to the existing 
form lines or underlying layout of the form. Once the CMS-1500 (02/12) 
has been approved, the CMS-1500 (08/05) will be discontinued after a 
form runoff period during which both the CMS-1500 (08/05) and the CMS-
1500 (02/12) can be used. Form Number: CMS-1500(02/12), CMS-1490-S 
(OMB: 0938-New); Frequency: Reporting--On occasion; Affected 
Public: State, Local, or Tribal Government, Business or other-for-
profit, Not-for-profit institutions; Number of Respondents: 1,448,346; 
Total Annual Responses: 988,005,045; Total Annual Hours: 21,418,336. 
(For policy questions regarding this collection contact Brian Reitz at 
410-786-5001. For all other issues call 410-786-1326.)
    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.
    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 July 30, 2012:
    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: May 22, 2012.
Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2012-12810 Filed 5-25-12; 8:45 am]
BILLING CODE 4120-01-P

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.