[Federal Register Volume 67, Number 96 (Friday, May 17, 2002)]
[Notices]
[Page 35116]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-12349]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-R-257]


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 (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 + Choice 
Disenrollment Form to original Medicare; Form No.: CMS-R-257 
(OMB 0938-0741); Use: Section 4001 of the Balanced Budget Act 
of 1997 amended the Social Security Act to add Section 1851; including 
1851(c) (1) which required the establishment of a procedure and form to 
make and change Medicare + Choice elections, which include 
disenrollment. In addition, BBA of 1997 also required information be 
provided to beneficiaries to make better informed choices. Certain 
information is needed from the beneficiary in order to process the 
disenrollment action as a change of election.; Frequency: On occasion; 
Affected Public: Individuals or Households, Business or other for-
profit, federal government, not-for-profit institutions; Number of 
Respondents: 50,000; Total Annual Responses: 50,000; Total Annual 
Hours: 3,300.
    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:, Room N2-14-26, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850.

    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. 02-12349 Filed 5-16-02; 8:45 am]
BILLING CODE 4120-03-P