[Federal Register Volume 67, Number 203 (Monday, October 21, 2002)]
[Notices]
[Pages 64640-64641]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-26652]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifiers: CMS-10074, CMS-R-0290, CMS-R-0285, & CMS-2744]


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: Program for the All-Inclusive Elderly Health 
Survey (PHS); Form No.: CMS-10074 (OMB 0938-NEW); Use: The 
Centers for Medicare & Medicaid Services has developed a survey, the 
PHS, that is similar to the Health Outcomes Survey (HOS). The main 
purpose of the PHS is to collect health status information that may be 
used to adjust Medicare payments to PACE organizations. It has been 
successfully pilot-tested to assess response rates and accuracy of 
responses under different distribution approaches. The pilot test 
enabled CMS to select an approach whereby PACE enrollees will be sent 
surveys to fill out and can request assistance from family or 
professionals.; Frequency: Annually; Affected Public: Individuals or 
Households, Not-for-profit institutions; Number of Respondents: 15,800; 
Total Annual Responses: 5,814; Total Annual Hours: 1082.
    (2) Type of Information Collection Request: Extension of a 
currently approved collection; Title of

[[Page 64641]]

Information Collection: Procedures for Making National Coverage 
Decisions; Form No.: CMS-R-0290 (OMB 0938-0776); Use: These 
information collection requirements provide the process CMS will use to 
make a national coverage decision for a specific item or service under 
sections 1862 and 1871 of the Social Security Act. This will streamline 
our decision making process and will increase the opportunities for 
public participation in making national coverage decisions; Frequency: 
Other (as needed); Affected Public: Business or other for-profit, Not-
for-profit institutions; Number of Respondents: 200; Total Annual 
Responses: 200; Total Annual Hours: 8,000.
    (3) Type of Information Collection Request: Extension of a 
currently approved collection; Title of Information Collection: Request 
for Retirement Benefit Information; Form No.: CMS-R-0285 (OMB 
0938-0769); Use: This information is needed to determine whether a 
beneficiary meets the requirements for reduction of the Part A premium 
to zero.; Frequency: On occasion.; Affected Public: State, Local or 
Tribal Government; Number of Respondents: 1,500; Total Annual 
Responses: 1,500; Total Annual Hours: 208.
    (4) Type of Information Collection Request: Extension of a 
currently approved collection; Title of Information Collection: End 
Stage Renal Disease Medical Information System ESRD Facility Survey; 
Form No.: CMS-2744 (OMB 0938-0447); Use: The ESRD Facility 
Survey form is completed annually by Medicare approved providers of 
dialysis and transplant services. The CMS-2744 is designed to collect 
information concerning treatment trends, utilization of services and 
patterns of practice in treating ESRD patients.; Frequency: Annually; 
Affected Public: Business or other for-profit, Not-for-profit 
institutions; Number of Respondents: 4,225; Total Annual Responses: 
4,225; Total Annual Hours: 33,800.
    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: October 10, 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. 02-26652 Filed 10-18-02; 8:45 am]
BILLING CODE 4120-03-P