[Federal Register Volume 68, Number 21 (Friday, January 31, 2003)]
[Notices]
[Pages 5024-5025]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-2239]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifiers: CMS-R-242, CMS-10069, CMS-10078, CMS-R-52, and 
CMS-R-30]


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: 
Refinement of RHC Certification and QAPI and Supporting Regulations in 
42 CFR 491.8 and 491.11; Form No.: CMS-R-242 (OMB 0938-0792); 
Use: This collection contains information collection requirements 
concerning requests for additional waivers of staffing requirements and 
documentation of quality assessment and performance improvement 
programs; Frequency: Annually; Affected Public: Business or other for-
profit; Number of Respondents: 3,528; Total Annual Responses: 3,573; 
Total Annual Hours: 3,663.
    (2) Type of Information Collection Request: Extension of a 
currently approved collection; Title of Information Collection: 
Medicare Waiver Demonstration Application; Form No.: CMS-10069 
(OMB 0938-0880); Use: The Medicare Waiver Demonstration 
Application will be used to collect standard information needed to 
implement Congressionally mandated and administration high priority 
demonstrations. The application will be used to gather information 
about the characteristics of the applicant's organization, benefits, 
and services they propose to offer, success in operating the model, and 
evidence that the model is likely to be successful in the Medicare 
program. The standard application will be used for all waiver 
demonstrations and will reduce the burden on applicants, provide for 
consistent and timely information collections across demonstration, and 
provide a user-friendly format for respondents; Frequency: On occasion; 
Affected Public: Business or other for-profit and not-for-profit 
institutions; Number of Respondents: 75; Total Annual Responses: 75; 
Total Annual Hours: 1600.
    (3) Type of Information Collection Request: Extension of a 
currently approved collection; Title of Information Collection: 
Matching Grants to States for the Operation of High Risk Pools; Form 
No.: CMS-10078 (OMB 0938-0887); Use: HHS/CMS is requiring this 
information as a condition of eligibility for grants that were 
authorized in the Trade Act of 2002 (Pub. L. 107-210). The information 
is necessary to determine if a state applicant meets the necessary 
eligibility criteria for a grant as required by the law. The 
respondents will be states that have a high risk pool as defined in 
section 2744(c)(2) of the Public Health Service Act. The grants will 
provide matching funds to states that incur losses in the operation of 
high risk pools. High risk pools are set up by states to provide heatlh 
insurance to individuals that cannot obtain health insurance in the 
private market because of a history of illness; Frequency: On occasion; 
Affected Public: State, local, or tribal government; Number of 
Respondents: 20; Total Annual Responses: 20; Total Annual Hours: 800.
    (4) Type of Information Collection Request: Extension of a 
currently approved collection; Title of Information Collection: 
Conditions of Coverage of Suppliers of End Stage Renal Disease (ESRD); 
Form No.: CMS-R-52 (OMB 0938-0386); Use: This package is 
needed to encourage proper distribution and effective utilization of 
ESRD treatment sources while maintaining and improving the efficient 
delivery of care by physicians and dialysis facilities; Frequency: 
Annually; Affected Public: Business or other for-profit and Federal 
Government; Number of Respondents: 4,297; Total Annual Responses: 
4,297; Total Annual Hours: 148,785.
    (5) Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Information 
Collection Requirements in the Hospice Conditions Coverage. The 
following

[[Page 5025]]

regulations are affected: 42 CFR 418.22; 418.24; 418.28; 418.56(b), 
(e)(1), (e)(3); 418.58; 418.70(e); 418.83; 418.96(b); and 418.100(b); 
Form No.: CMS-R-30 (OMB 0938-0302); Use: Establishes standards 
for hospices that wish to participate in the Medicare program. The 
regulations establish standards for eligibility, reimbursement 
standards and procedure, and delineate conditions that hospices must 
meet to be approved for participation in Medicare; Frequency: On 
occasion; Affected Public: Business or other for-profit; Number of 
Respondents: 2,316; Total Annual Responses: 2,316; Total Annual Hours: 
5,981,427.
    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: C5-14-03, 7500 
Security Boulevard, Baltimore, Maryland 21244-1850.

    Dated: January 23, 2003.
John P. Burke III,
CMS Reports Clearance Officer, Office of Strategic Operations and 
Strategic Affairs, Division of Regulations Development and Issuances.
[FR Doc. 03-2239 Filed 1-30-03; 8:45 am]
BILLING CODE 4120-03-P