[Federal Register Volume 67, Number 80 (Thursday, April 25, 2002)]
[Notices]
[Page 20521]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-10195]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-1500]


Agency Information Collection Activities: Submission for OMB 
Review; 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 (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: Medicare/Medicaid 
Health Insurance Common Claim Form, Instructions, and Supporting 
Regulations in 42 CFR 414.40, 424.32, 424.44; Form No.: CMS-1500 (OMB# 
0938-0008); Use: This form is a standardized claim form for use in the 
Medicare/Medicaid programs to apply for reimbursement for covered 
services. Many private insurers also use this form; Frequency: On 
occasion; Affected Public: State, Local, or Tribal Government, Not-for-
profit institutions, business or other for-profit; Number of 
Respondents: 1,216,702; Total Annual Responses: 740,215,135; Total 
Annual Hours: 42,941,276.
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access CMS' 
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 30 days of this notice directly to the OMB desk officer: OMB 
Human Resources and Housing Branch, Attention: Allison Eydt, New 
Executive Office Building, Room 10235, Washington, DC 20503.

    Dated: April 16, 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. 02-10195 Filed 4-24-02; 8:45 am]
BILLING CODE 4120-03-P