[Federal Register Volume 67, Number 188 (Friday, September 27, 2002)]
[Notices]
[Pages 61114-61115]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-24586]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifiers: CMS-10073, CMS-1557, CMS-1500, CMS-1490U, CMS-
1490S CMS-1450]


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.
    (1) Type of Information Collection Request: New Collection; Title 
of Information Collection: Survey of Rural Medicare Providers Regarding 
Provider Education Needs; Form No.: CMS-10073 (OMB 0938-NEW); 
Use: The Division of Provider Education and Training, Centers for 
Medicare and Medicaid Services (CMS), is requesting Office of 
Management and Budget (OMB) approval to conduct a survey of the 
provider education needs of rural Medicare providers. CMS has 
contracted The Lewin Group to develop and field the survey instrument, 
analyze and synthesize the information collected, and present findings 
and recommendations to help CMS better understand the provider 
education needs of rural providers. The study will also provide an 
assessment of the specific and unique education challenges faced by 
rural Medicare providers and the success of current education methods 
in meeting those challenges; Frequency: Other: One-time; Affected 
Public: Business or other for-profit and Not-for-profit institutions; 
Number of Respondents: 1,832; Total Annual Responses: 1,832; Total 
Annual Hours: 608.
    (2) Type of Information Collection Request: Extension of a 
currently approved collection; Title of Information Collection: Survey 
Report Form Clinical Laboratory Improvement Amendments (CLIA) and 
Supporting Regulations in 42 CFR 493.1-493.2001; Form No.: CMS-1557 
(OMB 0938-0544); Use: CLIA requires the Department of Health 
and Human Services (DHHS) to establish certification requirements for 
any laboratory that performs tests on human specimens, and to certify 
through the issuance of a certificate that those laboratories meet the 
requirements established by DHHS. The information collected on this 
survey form is used in the administrative pursuit of the 
Congressionally-mandated program with regard to regulation of 
laboratories participating in CLIA. In order for the State survey 
agency to report to CMS its findings on facility compliance with the 
individual standards on which CMS determines compliance, the surveyor 
completes the Survey Report Form. The Survey Worksheet provides space 
to document the surveyor's notes; Frequency: Biennially; Affected 
Public: Business or other for profit, Not for profit institutions, and 
State, Local or Tribal Government; Number of Respondents: 26,500; Total 
Annual Responses: 13,250; Total Annual Hours: 6,625.
    (3) Type of Information Collection Request: Extension of a 
currently approved collection; Title of Information Collection: 
Flexibility in Payment Methods for Hospitals, Nursing Facilities, and 
Intermediate Care Facilities for the Mentally Retarded and Supporting 
Regulations in 42 CFR 447.254; Form No.: CMS-R-252 (OMB 0938-
0784); Use: Section 4711 of BBA 1997 replaced the Boren requirements 
with Section 1902(a)(13)(A), which requires States to use a public 
process for determining institutional payment rates and publish 
proposed and final rates, underlying methodologies and

[[Page 61115]]

justifications. Hospital rates must take into account the situation of 
hospitals that serve a disproportionate number of low-income patients 
with special needs; Frequency: Once; Affected Public: State local, or 
tribal gov't; Number of Respondents: 54; Total Annual Responses: 108; 
Total Annual Hours: 27.
    (4) Type of Information Request: Extension of a currently approved 
collection; Title of Information Collection: Medicare/Medicaid Health 
Insurance Common Claim Form, Instructions, and Supporting Regulations: 
42 CFR 414.40, 424.32, 424.44; Form Number: CMS-1500, CMS-1490U, CMS-
1490S (OMB : 0938-0008); Use: This form is a standardized form 
for use in the Medicare/Medicaid programs to apply for reimbursement 
for covered services. Many private insurers also use this form. Use of 
this form reduces cost and administrative burdens associated with 
professional claims because only one format needs to be used and 
maintained. CMS does not require exclusive use of this form for 
Medicaid.; Frequency: On occasion; Affected Public: State, Local or 
Tribal Government, Business or other for-profit, Not-for-profit 
institutions; Number of Respondents: 1,216,702; Total Annual Responses: 
740,215,135; Total Annual Hours Requested: 42,941,276.
    (5) Type of Information Request: Extension of a currently approved 
collection; Title of Information Collection: Medicare Uniform 
Institutional Provider Bill and Supporting Regulations in 42 CFR 424.5; 
Form Number: CMS-1450 (OMB : 0938-0247); Use: This 
standardized form is used in the Medicare/Medicaid program to apply for 
reimbursement of covered services by all providers that accept 
Medicare/Medicaid assigned claims; Frequency: On occasion; Affected 
Public: Business or other for-profit, Not-for-profit institutions; 
Number of Respondents: 46,708; Total Annual Responses: 158,603,290; 
Total Annual Hours Requested: 1,666,208.
    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 Strategic 
Operations and Regulatory Affairs, Division of Regulations Development 
and Issuances, Attention: Dawn Willinghan, Room N2-14-26, 7500 Security 
Boulevard, Baltimore, Maryland 21244-1850.

    Dated: September 19, 2002.
John P. Burke III,
Paperwork Reduction Act Team Leader, CMS Reports Clearance Officer, 
Office of Strategic Operations and Strategic Affairs, Division of 
Regulations Development and Issuances.
[FR Doc. 02-24586 Filed 9-26-02; 8:45 am]
BILLING CODE 4120-03-P