Agency Information Collection Activities: Submission for OMB Review; Comment Request, 65817-65818 [2019-25861]
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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 ............................................................................
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16:49 Nov 27, 2019
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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
