[Federal Register Volume 68, Number 7 (Friday, January 10, 2003)]
[Notices]
[Page 1468]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-483]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[CMS-10024, CMS-10041, CMS-377/378 and CMS-R-54]


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: Revision of a currently 
approved collection; Title of Information Collection: Medicare Health 
Survey (MHS); Form No.: CMS-10024 (OMB 0938-0844)

    (Note: This collection was published under CMS-10074/0938-NEW 
during the 60-day Federal Register notice comment period).

    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: 8,550; 
Total Annual Responses: 5,814; Total Annual Hours: 1082.
    (2) Type of Information Collection Request: Extension of a 
currently approved collection; Title of Information Collection: Long 
Term Care Awareness Project; Form No.: CMS-10041 (OMB 0938-
0825); Use: CMS-CBC needs to collect these data to pilot test a 
national campaign to educate current and future Medicare beneficiaries 
and their families about long term health care needs, as requested in 
the Presidential Initiative for Fiscal Year 2000 Budget. Project 
findings will be used to design and implement a nationwide campaign. 
Respondents will be from two groups: 55-70 year-olds and persons with 
disability who are 18-64 years of age; Frequency: Quarterly; Affected 
Public: Individuals or households; Number of Respondents: 2000; Total 
Annual Responses: 2000; Total Annual Hours: 667.
    (3) Type of Information Collection Request: Extension of a 
currently approved collection; Title of Information Collection: Request 
for Certification, CMS-377 and the Ambulatory Surgical Center Survey 
Report Form, CMS-378 and CMS-R-0054 Supporting Regulations Contained in 
42 CFR 416.1 thru 416.49; Form No.: CMS-0377/0378/R-0054 (OMB 
0938-0200); Use: The ASC request for certification form is utilized as 
an application for facilities wishing to participate in the Medicare 
program as an ASC. This form initiates the process of obtaining a 
decision as to whether the conditions of coverage are met. It also 
promotes data retrieval from the Online Data Input Edit (ODIE system, a 
subsystem of the Online Survey Certification and Report (OSCAR) system 
by CMS Regional Offices (RO)). The ASC report form is an instrument 
used by the State survey agency to record data collection in order to 
determine supplier compliance with individual conditions of coverage 
and to report it to the Federal government. The form is primarily a 
coding worksheet designed to facilitate data reduction and retrieval 
into the ODIE/OSCAR system at the HCFA ROs. This form includes basic 
information on compliance (i.e., met, not met and explanatory 
statements) and does not require any descriptive information regarding 
the survey activity itself.; Frequency: Annually; Affected Public: 
State, Local, or Tribal Government; Number of Respondents: 3,600; Total 
Annual Responses: 3,675; Total Annual Hours: 1,875. 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://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 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: January 2, 2003.
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. 03-483 Filed 1-9-03; 8:45 am]
BILLING CODE 4120-03-P