Agency Information Collection Activities: Submission for OMB Review; Comment Request, 65817-65818 [2019-25861]

Download as PDF Federal Register / Vol. 84, No. 230 / Friday, November 29, 2019 / Notices other company, in a nonbanking activity that is listed in § 225.28 of Regulation Y (12 CFR 225.28) or that the Board has determined by Order to be closely related to banking and permissible for bank holding companies. Unless otherwise noted, these activities will be conducted throughout the United States. Each notice is available for inspection at the Federal Reserve Bank indicated. The notice also will be available for inspection at the offices of the Board of Governors. Interested persons may express their views in writing on the question whether the proposal complies with the standards of section 4 of the BHC Act. Unless otherwise noted, comments regarding the applications must be received at the Reserve Bank indicated or the offices of the Board of Governors, Ann E. Misback, Secretary of the Board, 20th Street and Constitution Avenue NW, Washington, DC 20551–0001, not later than December 12, 2019. A. Federal Reserve Bank of St. Louis (David L. Hubbard, Senior Manager) P.O. Box 442, St. Louis, Missouri 63166–2034. Comments can also be sent electronically to Comments.applications@stls.frb.org: 1. First Waterloo Bancshares, Inc., Waterloo, Illinois; to acquire Best Hometown Bancorp, Inc., and thereby indirectly acquire Best Hometown Bank, both of Collinsville, Illinois, and thereby operate a savings association pursuant to section 4(c)(8) of the BHC Act. Board of Governors of the Federal Reserve System, November 22, 2019. Yao-Chin Chao, Assistant Secretary of the Board. [FR Doc. 2019–25817 Filed 11–27–19; 8:45 am] BILLING CODE P DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [Document Identifier CMS–1500/1490S, CMS–10704 and CMS–10338] Agency Information Collection Activities: Submission for OMB Review; Comment Request Centers for Medicare & Medicaid Services, HHS. ACTION: Notice. khammond on DSKJM1Z7X2PROD with NOTICES AGENCY: The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS’ intention to collect information from the public. Under the Paperwork Reduction Act of 1995 SUMMARY: VerDate Sep<11>2014 16:49 Nov 27, 2019 Jkt 250001 (PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, and to allow a second opportunity for public comment on the notice. Interested persons are invited to send comments regarding the burden estimate or any other aspect of this collection of information, including the necessity and utility of the proposed information collection for the proper performance of the agency’s functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection techniques or other forms of information technology to minimize the information collection burden. DATES: Comments on the collection(s) of information must be received by the OMB desk officer by December 30, 2019. ADDRESSES: When commenting on the proposed information collections, please reference the document identifier or OMB control number. To be assured consideration, comments and recommendations must be received by the OMB desk officer via one of the following transmissions: OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk Officer, Fax Number: (202) 395–5806 OR, Email: OIRA_submission@omb.eop.gov. To obtain copies of a supporting statement and any related forms for the proposed collection(s) summarized in this notice, you may make your request using one of following: 1. Access CMS’ website address at website address at https://www.cms.gov/ Regulations-and-Guidance/Legislation/ PaperworkReductionActof1995/PRAListing.html. 1. Email your request, including your address, phone number, OMB number, and CMS document identifier, to Paperwork@cms.hhs.gov. 2. Call the Reports Clearance Office at (410) 786–1326. FOR FURTHER INFORMATION CONTACT: William Parham at (410) 786–4669. SUPPLEMENTARY INFORMATION: Under the Paperwork Reduction Act of 1995 (PRA) (44 U.S.C. 3501–3520), federal agencies must obtain approval from the Office of Management and Budget (OMB) for each collection of information they conduct or sponsor. The term ‘‘collection of information’’ is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members of the public submit reports, keep records, or provide information to a third party. Section PO 00000 Frm 00042 Fmt 4703 Sfmt 4703 65817 3506(c)(2)(A) of the PRA (44 U.S.C. 3506(c)(2)(A)) requires federal agencies to publish a 30-day notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, before submitting the collection to OMB for approval. To comply with this requirement, CMS is publishing this notice that summarizes the following proposed collection(s) of information for public comment: 1. Type of Information Collection Request: Extension without change of a currently approved collection; Title of Information Collection: Health Insurance Common Claims Form and Supporting Regulations at 42 CFR part 424, subpart C (CMS–1500 and CMS– 1490S); Use: Social Security ACT, Part E, Section 1861(s) provides definition of services and institutions covered under the Act. The CMS–1500 is used to bill for services covered under section 1861(a)(1) by persons entitled to payment for such services. Benefits are paid either to the physician/supplier under an agreement, the beneficiary on the basis of an itemized bill per section 1842(b)(3)(B)(i) and (ii) of the Social Security Act, or to an organization authorized to receive payment per 1842(b)(6). The CMS–1500 and the CMS–1490S forms are used to deliver information to CMS in order for CMS to reimburse for provided services. Medicare Administrative Contractors 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., TRICARE, RRB, and Medicaid). 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 Medical Payment) was explicitly developed for easy use by beneficiaries who file their own claims. The English and Spanish version CMS– 1490S form (version 01/18) can be obtained from a Medicare Administrative Contractor or online. Form Number: CMS–1500/1490S (OMB control number: 0938–1197); Frequency: Yearly; Affected Public: State, Local, or E:\FR\FM\29NON1.SGM 29NON1 65818 Federal Register / Vol. 84, No. 230 / Friday, November 29, 2019 / Notices Tribal Governments; Number of Respondents: 2,029,505; Total Annual Responses: 1,033,839,906; Total Annual Hours: 18,847,500. (For policy questions regarding this collection contact Charlene Parks at 410–786–8684.) 2. Type of Information Collection Request: Extension of a currently approved collection; Title of Information Collection: Health Reimbursement Arrangements and Other Account-Based Group Health Plans; Use: On June 20, 2019, the Department of the Treasury, the Department of Labor, and the Department of Health and Human Services (collectively, the Departments) issued final regulations titled ‘‘Health Reimbursement Arrangements and Other Account-Based Group Health Plans’’ (84 FR 28888) under section 2711 of the PHS Act and the health nondiscrimination provisions of HIPAA, Public Law 104–191 (HIPAA nondiscrimination provisions). The regulations expand the use of health reimbursement arrangements and other account-based group health plans (collectively referred to as HRAs). In general, the regulations expand the use of HRAs by eliminating the current prohibition on integrating HRAs with individual health insurance coverage, thereby permitting employers to offer individual coverage HRAs to employees that can be integrated with individual health insurance coverage or Medicare. Under the regulations employees will be permitted to use amounts in an individual coverage HRA to pay expenses for medical care (including premiums for individual health insurance coverage and Medicare), subject to certain requirements. This information collection includes provisions related to substantiation of individual health insurance coverage (45 CFR 146.123(c)(5)), the notice requirement for individual coverage HRAs (45 CFR 146.123(c)(6)), and notification of termination of coverage (45 CFR 146.123(c)(1)(iii)). Form Number: CMS–10704 (OMB Control Number 0938–1361); Frequency: Annually; Affected Public: Private Sector, State Governments; Number of Respondents: 2,005; Total Annual Responses: 273,492; Total Annual Hours: 6,016. (For policy questions regarding this collection contact Usree Bandyopadhyay at 410–786–6650.) 3. Type of Information Collection Request: Extension without change of a currently approved collection; Title of Information Collection: Affordable Care Act Internal Claims and Appeals and External Review Procedures for Nongrandfathered Group Health Plans and Issuers and Individual Market Issuers; Use: The information collection requirements ensure that claimants receive adequate information regarding the plan’s claims procedures and the plan’s handling of specific benefit claims. Claimants need to understand plan procedures and plan decisions in order to appropriately request benefits and/or appeal benefit denials. The information collected in connection with the HHS-administered federal external review process is collected by HHS, and is used to provide claimants with an independent external review. Form Number: CMS–10338 (OMB control number: 0938–1099); Frequency: Occasionally; Affected Public: State, Local, or Tribal Governments; Number of Respondents: 109,653; Total Annual Responses: 4,711; Total Annual Hours: 1,195,626. (For policy questions regarding this collection contact Laura Byabazaire at 410–786–6650.) Dated: November 25, 2019. William N. Parham, III, Director, Paperwork Reduction Staff, Office of Strategic Operations and Regulatory Affairs. [FR Doc. 2019–25861 Filed 11–27–19; 8:45 am] BILLING CODE 4120–01–P DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Proposed Information Collection Activity; Intergovernmental Reference Guide (IRG) OMB #0970–0209 Office of Child Support Enforcement, Administration for Children and Families, HHS. AGENCY: ACTION: Request for public comment. The Intergovernmental Reference Guide (IRG) is a centralized and automated repository of state and tribal profiles that contains high-level descriptions of each state and tribal child support enforcement (CSE) program. These profiles provide state, tribal, and foreign country CSE agencies with an effective and efficient method for updating and accessing information needed to process intergovernmental child support cases. SUMMARY: Comments due within 60 days of publication. In compliance with the requirements of Section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Administration for Children and Families is soliciting public comment on the specific aspects of the information collection described above. DATES: Copies of the proposed collection of information can be obtained and comments may be forwarded by emailing infocollection@ acf.hhs.gov. Alternatively, copies can also be obtained by writing to the Administration for Children and Families, Office of Planning, Research and Evaluation, 330 C Street SW, Washington, DC 20201, Attn: ACF Reports Clearance Officer. All requests, emailed or written, should be identified by the title of the information collection. ADDRESSES: SUPPLEMENTARY INFORMATION: Description: The Office of Child Support Enforcement (OCSE) is proposing to add a new section (Section O) with six questions pertaining to family violence in the state profile. This will help process intergovernmental cases with family violence and help ensure the safety of children and families. OCSE is also proposing to delete Sections A–L (140 questions) from the tribal profile and create new sections (Sections A–D) with 11 questions regarding case processing. This will assist in the efficient processing of paternity and support obligations. Respondents: State and tribal CSE agencies. khammond on DSKJM1Z7X2PROD with NOTICES ANNUAL BURDEN ESTIMATES Total number of respondents Information collection instrument IRG: State Profile Guidance (states and territories) ........................................ IRG: Tribal Profile Guidance ............................................................................ VerDate Sep<11>2014 16:49 Nov 27, 2019 Jkt 250001 PO 00000 Frm 00043 Fmt 4703 Sfmt 4703 Number of responses per respondent 54 62 E:\FR\FM\29NON1.SGM 18 18 29NON1 Average burden hour per response 0.3 0.3 Annual burden hours 292 335

Agencies

[Federal Register Volume 84, Number 230 (Friday, November 29, 2019)]
[Notices]
[Pages 65817-65818]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-25861]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier CMS-1500/1490S, CMS-10704 and CMS-10338]


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

AGENCY: Centers for Medicare & Medicaid Services, HHS.

ACTION: Notice.

-----------------------------------------------------------------------

SUMMARY: The Centers for Medicare & Medicaid Services (CMS) is 
announcing an opportunity for the public to comment on CMS' intention 
to collect information from the public. Under the Paperwork Reduction 
Act of 1995 (PRA), federal agencies are required to publish notice in 
the Federal Register concerning each proposed collection of 
information, including each proposed extension or reinstatement of an 
existing collection of information, and to allow a second opportunity 
for public comment on the notice. Interested persons are invited to 
send comments regarding the burden estimate or any other aspect of this 
collection of information, including the necessity and utility of the 
proposed information collection for the proper performance of the 
agency's functions, the accuracy of the estimated burden, ways to 
enhance the quality, utility, and clarity of the information to be 
collected, and the use of automated collection techniques or other 
forms of information technology to minimize the information collection 
burden.

DATES: Comments on the collection(s) of information must be received by 
the OMB desk officer by December 30, 2019.

ADDRESSES: When commenting on the proposed information collections, 
please reference the document identifier or OMB control number. To be 
assured consideration, comments and recommendations must be received by 
the OMB desk officer via one of the following transmissions: OMB, 
Office of Information and Regulatory Affairs, Attention: CMS Desk 
Officer, Fax Number: (202) 395-5806 OR, Email: 
[email protected].
    To obtain copies of a supporting statement and any related forms 
for the proposed collection(s) summarized in this notice, you may make 
your request using one of following:
    1. Access CMS' website address at website address at https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html.
    1. Email your request, including your address, phone number, OMB 
number, and CMS document identifier, to [email protected].
    2. Call the Reports Clearance Office at (410) 786-1326.

FOR FURTHER INFORMATION CONTACT: William Parham at (410) 786-4669.

SUPPLEMENTARY INFORMATION: Under the Paperwork Reduction Act of 1995 
(PRA) (44 U.S.C. 3501-3520), federal agencies must obtain approval from 
the Office of Management and Budget (OMB) for each collection of 
information they conduct or sponsor. The term ``collection of 
information'' is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and 
includes agency requests or requirements that members of the public 
submit reports, keep records, or provide information to a third party. 
Section 3506(c)(2)(A) of the PRA (44 U.S.C. 3506(c)(2)(A)) requires 
federal agencies to publish a 30-day notice in the Federal Register 
concerning each proposed collection of information, including each 
proposed extension or reinstatement of an existing collection of 
information, before submitting the collection to OMB for approval. To 
comply with this requirement, CMS is publishing this notice that 
summarizes the following proposed collection(s) of information for 
public comment:
    1. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
Health Insurance Common Claims Form and Supporting Regulations at 42 
CFR part 424, subpart C (CMS-1500 and CMS-1490S); Use: Social Security 
ACT, Part E, Section 1861(s) provides definition of services and 
institutions covered under the Act. The CMS-1500 is used to bill for 
services covered under section 1861(a)(1) by persons entitled to 
payment for such services. Benefits are paid either to the physician/
supplier under an agreement, the beneficiary on the basis of an 
itemized bill per section 1842(b)(3)(B)(i) and (ii) of the Social 
Security Act, or to an organization authorized to receive payment per 
1842(b)(6).
    The CMS-1500 and the CMS-1490S forms are used to deliver 
information to CMS in order for CMS to reimburse for provided services. 
Medicare Administrative Contractors 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., TRICARE, 
RRB, and Medicaid). 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 Medical 
Payment) was explicitly developed for easy use by beneficiaries who 
file their own claims. The English and Spanish version CMS-1490S form 
(version 01/18) can be obtained from a Medicare Administrative 
Contractor or online. Form Number: CMS-1500/1490S (OMB control number: 
0938-1197); Frequency: Yearly; Affected Public: State, Local, or

[[Page 65818]]

Tribal Governments; Number of Respondents: 2,029,505; Total Annual 
Responses: 1,033,839,906; Total Annual Hours: 18,847,500. (For policy 
questions regarding this collection contact Charlene Parks at 410-786-
8684.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Health 
Reimbursement Arrangements and Other Account-Based Group Health Plans; 
Use: On June 20, 2019, the Department of the Treasury, the Department 
of Labor, and the Department of Health and Human Services 
(collectively, the Departments) issued final regulations titled 
``Health Reimbursement Arrangements and Other Account-Based Group 
Health Plans'' (84 FR 28888) under section 2711 of the PHS Act and the 
health nondiscrimination provisions of HIPAA, Public Law 104-191 (HIPAA 
nondiscrimination provisions). The regulations expand the use of health 
reimbursement arrangements and other account-based group health plans 
(collectively referred to as HRAs). In general, the regulations expand 
the use of HRAs by eliminating the current prohibition on integrating 
HRAs with individual health insurance coverage, thereby permitting 
employers to offer individual coverage HRAs to employees that can be 
integrated with individual health insurance coverage or Medicare. Under 
the regulations employees will be permitted to use amounts in an 
individual coverage HRA to pay expenses for medical care (including 
premiums for individual health insurance coverage and Medicare), 
subject to certain requirements. This information collection includes 
provisions related to substantiation of individual health insurance 
coverage (45 CFR 146.123(c)(5)), the notice requirement for individual 
coverage HRAs (45 CFR 146.123(c)(6)), and notification of termination 
of coverage (45 CFR 146.123(c)(1)(iii)). Form Number: CMS-10704 (OMB 
Control Number 0938-1361); Frequency: Annually; Affected Public: 
Private Sector, State Governments; Number of Respondents: 2,005; Total 
Annual Responses: 273,492; Total Annual Hours: 6,016. (For policy 
questions regarding this collection contact Usree Bandyopadhyay at 410-
786-6650.)
    3. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
Affordable Care Act Internal Claims and Appeals and External Review 
Procedures for Non-grandfathered Group Health Plans and Issuers and 
Individual Market Issuers; Use: The information collection requirements 
ensure that claimants receive adequate information regarding the plan's 
claims procedures and the plan's handling of specific benefit claims. 
Claimants need to understand plan procedures and plan decisions in 
order to appropriately request benefits and/or appeal benefit denials. 
The information collected in connection with the HHS-administered 
federal external review process is collected by HHS, and is used to 
provide claimants with an independent external review. Form Number: 
CMS-10338 (OMB control number: 0938-1099); Frequency: Occasionally; 
Affected Public: State, Local, or Tribal Governments; Number of 
Respondents: 109,653; Total Annual Responses: 4,711; Total Annual 
Hours: 1,195,626. (For policy questions regarding this collection 
contact Laura Byabazaire at 410-786-6650.)

    Dated: November 25, 2019.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2019-25861 Filed 11-27-19; 8:45 am]
 BILLING CODE 4120-01-P