[Federal Register Volume 67, Number 22 (Friday, February 1, 2002)]
[Notices]
[Page 4983]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-2444]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-1500]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare and 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 and Medicaid 
Services (formerly the Health Care Financing Administration), 
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 
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.
    Type of Information Request: Extension of a currently approved 
collection; Title of Information Collection: Medicare/Medicaid Health 
Insurance Common Claim Form, Instructions, and Supporting Regulations: 
42 CFR 414.40, 424.32, 424.44; Form Number: CMS-1500, CMS-1490U, CMS-
1490S (OMB #: 0938-0008); Use: This form is a standardized form for use 
in the Medicare/Medicaid programs to apply for reimbursement for 
covered services. Many private insurers also use this form. Use of this 
form reduces cost and administrative burdens associated with 
professional claims because only one format needs to be used and 
maintained. CMS does not require exclusive use of this form for 
Medicaid.; Frequency: On occasion; Affected Public: State, Local or 
Tribal Government, Business or other for-profit, Not-for-profit 
institutions; Number of Respondents: 1,216,702; Total Annual Responses: 
740,215,135; Total Annual Hours Requested: 42,941,276.
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access CMS's 
Web site address at http://www.hcfa.gov/regs/prdact95.htm, or e-mail 
your request, including your address, phone number, OMB number, and CMS 
document identifier, to [email protected], or call the Reports 
Clearance Office on (410) 786-1326. Written comments and 
recommendations for the proposed information collections must be mailed 
within 60 days of this notice directly to the CMS Paperwork Clearance 
Officer designated at the following address: CMS, Office of Information 
Services, Security and Standards Group, Division of CMS Enterprise 
Standards, Attention: Melissa Musotto, Room N2-14-26, 7500 Security 
Boulevard, Baltimore, Maryland 21244-1850

    Dated: January 23, 2002.
John P. Burke, III,
CMS Reports Clearance Officer, CMS Office of Information Services, 
Security and Standards Group, Division of CMS Enterprise Standards.
[FR Doc. 02-2444 Filed 1-31-02; 8:45 am]
BILLING CODE 4120-03-P