[Federal Register Volume 67, Number 42 (Monday, March 4, 2002)]
[Notices]
[Page 9741]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-4970]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-1771]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare and Medicaid Services.
    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 (CMS) (formerly known as the Health Care Financing 
Administration (HCFA)), 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 Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Attending 
Physicians Statement and Documentation of Medicare Emergency and 
Supporting Regulations in 42 CFR Section 424.103; Form No.: CMS-1771 
(OMB# 0938-0023); Use: Payment, by Medicare, may be made for certain 
Part A inpatient hospital services and Part B outpatient services 
provided in a nonparticipating U.S. or foreign hospital, when services 
are necessary to prevent the death or serious impairment to the health 
of an individual. This form is used to document the attending 
physician's statement that the hospitalization was required due to an 
emergency and give clinical support for the claim:
    Frequency: On occasion;
    Affected Public: Business or other for profit;
    Number of Respondents: 2,000;
    Total Annual Responses: 2,000;
    Total Annual Hours: 500.
    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: Dawn Willinghan, CMS-1771, Room N2-14-26, 7500 
Security Boulevard, Baltimore, Maryland 21244-1850.

    Dated: February 20, 2002.
John P. Burke, III,
Reports Clearance Officer, Security and Standards Group, Division of 
CMS Enterprise Standards.
[FR Doc. 02-4970 Filed 3-1-02; 8:45 am]
BILLING CODE 4120-03-P