[Federal Register Volume 67, Number 96 (Friday, May 17, 2002)]
[Notices]
[Pages 35117-35118]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-12347]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-1771]


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,

[[Page 35118]]

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 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 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: May 7, 2002.
John P. Burke III,
Paperwork Reduction Act Team Leader, CMS Reports Clearance Officer, CMS 
Office of Information Services, Security and Standards Group, Division 
of CMS Enterprise Standards.
[FR Doc. 02-12347 Filed 5-16-02; 8:45 am]
BILLING CODE 4120-03-P