[Federal Register Volume 67, Number 188 (Friday, September 27, 2002)]
[Notices]
[Page 61115]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-24585]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-R-137 and CMS-R-257]


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.
    (1) Type of Information Collection Request: Extension of a 
currently approved collection; Title of Information Collection: 
Internal Revenue Service/Social Security Administration / Health Care 
Financing Administration Data Match and Supporting Regulations in 42 
CFR 411.20-411.206; Form No.: CMS-R-137; Use: Employers who are 
identified through a match of IRS, SSA, and Medicare records will be 
contacted concerning group health plan coverage of identified 
individuals to ensure compliance with Medicare Secondary Payer 
provisions found at 42 U.S.C. 1395y(b). Frequency: Annually; Affected 
Public: Federal Government, Business or other for profit, Not for 
profit institutions, Farms, Federal Government and State, Local or 
Tribal Government; Number of Respondents: 327,947; Total Annual 
Responses: 327,947; Total Annual Hours Requested: 1,096,466.
    (2) 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 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: Brenda Aguilar, New 
Executive Office Building, Room 10235, Washington, DC 20503.

    Dated: September 19, 2002.
John P. Burke III,
Paperwork Reduction Act Team Leader, CMS Reports Clearance Officer, 
Office of Strategic Operations and Regulatory Affairs, Division of 
Regulations Development and Issuances.
[FR Doc. 02-24585 Filed 9-26-02; 8:45 am]
BILLING CODE 4120-03-P