[Federal Register Volume 67, Number 231 (Monday, December 2, 2002)]
[Notices]
[Pages 71570-71571]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-30366]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifiers: CMS-R-5, CMS-R-96, CMS-209]


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: Extension of a 
currently approved collection; Title of Information Collection: 
Physician Certifications/Recertifications in Skilled Nursing Facilities 
(SNFs) Manual Instructions and Supporting Regulations in 42 CFR Section 
424.20; Form No.: CMS-R-5 (OMB 0938-0454); Use: This 
information collection requires SNFs to keep record of physician 
certifications and recertifications of information such as the need for 
care and services, estimated duration of the SNF stay, and plan for 
home care.; Frequency: On occasion; Affected Public: State, local or 
tribal government, individuals or households, business or other for-
profit, not-for-profit institutions; Number of Respondents: 2,068,716; 
Total Annual Responses: 883,838; Total Annual Hours: 441,793.
    (2) Type of Information Collection Request: Extension of a 
currently approved collection; Title of Information Collection: 
Emergency and Foreign Hospital Services-Beneficiary Statement in 
Canadian Travel Claims and Supporting Regulations in 42 CFR, Section 
424.123; Form No.: CMS-R-96 (OMB 0938-0484); Use: Payment may 
be made for certain part A inpatient hospital services and part B 
outpatient hospital services provided in a non-participating U.S. or 
foreign hospital when services are necessary to prevent the death or 
serious impairment of the health of the individual. This statement must 
be submitted by the beneficiary to support their claim for payment.; 
Frequency: On occasion; Affected Public: Individuals or households; 
Number of Respondents: 1,100; Total

[[Page 71571]]

Annual Responses: 1,100; Total Annual Hours: 275.
    (3) Type of Information Collection Request: Extension of a 
currently approved collection; Title of Information Collection: 
Laboratory Personnel Report Clinical Laboratory Improvement Amendments 
(CLIA) and Supporting Regulations in 42 CFR 493.1--493.2001; Form No.: 
HCFA-0209 (OMB 0938-0151); 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. Information on personnel 
qualifications of all technical personnel is needed to ensure the 
sample is representative of all laboratories; Frequency: Biennially; 
Affected Public: Business or other for profit, not for profit 
institutions, Federal government, and State, local or tribal 
government; Number of Respondents: 22,500; Total Annual Responses: 
11,250; Total Annual Hours: 5,625.
    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://cms.hhs.gov/regulations/pra/default.asp, 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: November 21, 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. 02-30366 Filed 11-29-02; 8:45 am]
BILLING CODE 4120-03-P