[Federal Register Volume 68, Number 59 (Thursday, March 27, 2003)]
[Notices]
[Pages 14991-14992]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-7305]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-10042, CMS-10081, CMS-843, CMS-841, 842, 844-
853, CMS-484, and CMS-R-13]


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

AGENCY: Centers for Medicare and Medicaid Services.
    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: Medicare Part A Provider and Durable Medical 
Equipment Supplier Satisfaction Study; Form No.: CMS-10042 
(OMB 0938-NEW); Use: This is a request for clearance of a 
survey questionnaire to conduct a standardized random sample of Part A 
providers' and DME suppliers' satisfaction of their experience with 
their Medicare contractor's performance in its administration of the 
Medicare-fee-for-service program. The purpose of this study is to 
develop a baseline measure of providers' and suppliers' satisfaction 
with Medicare contractors by administering a survey to 15,000 providers 
and suppliers, 5,000 serviced by each of the following contractors: 
Connecticut General Life Insurance Company (CIGNA)-D, Palmetto 
Government Business Administrators (PBGA)-D, and United Government 
Services, LLC (UGS)-Part A. The data collected will be interpreted to 
produce indicators of the contractor's quality of performance.; 
Frequency: Annually; Affected Public: Business or other for-profit, and 
Not-for-profit institutions; Number of Respondents: 4,500; Total Annual 
Responses: 4,500; Total Annual Hours: 1,125.
    2. Type of Information Request: New Collection; Title of 
Information Collection: Data Collection for Administering the Survey 
for the Evaluation of the Demonstration to Maintain Independence and 
Employment (DMIE); Form No.: CMS-10081 (OMB 0938-NEW); Use: 
The DMIE Programs, funded by CMS under Title II of the Federal Ticket 
to Work Legislation, provide Medicaid coverage to low-income working 
populations, The Survey Evaluation is designed to assess the impact of 
the Mississippi DMIE program on access to care, health status and 
quality of life, workforce participation, etc.; Frequency: Annually; 
Affected Public: Individuals or Households, and State, Local or Tribal 
Govt.; Number of Respondents: 928; Total Annual Responses: 928; Total 
Annual Hours: 253.
    3. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Durable Medicare 
Equipment Regional Carrier, Certificate of Medical Necessity and 
Supporting Documentation Requirements ; Form No.: CMS-843 (OMB 
0938-0875); Use: This information is needed to correctly process claims 
and ensure that claims are properly paid. These forms contain medical 
information and supporting documentation necessary to make appropriate 
claims determinations. Suppliers and physicians will complete these 
forms and as needed supply additional routine supporting documentation 
necessary to process claims; Frequency: On occasion; Affected Public: 
Business or other for-profit, Federal Government, Not-for-profit 
institutions; Number of Respondents: 2,700; Total Annual Responses: 
141,900; Total Annual Hours: 30,100.
    4. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Durable Medical 
Equipment Regional Carrier, Certificate of Medical Necessity and 
Supporting Documentation Requirements; Form No.: CMS-841, 842, 844-853 
(OMB 0938-0679); Use: This information is needed to correctly 
process claims and ensure that claims are properly paid. These forms 
and supporting documentation contain medical information necessary to 
make appropriate claims determinations. Suppliers and physicians will 
complete these forms and as needed supply additional routine supporting 
documentation necessary to process claims; Frequency: On occasion; 
Affected Public: Business or other for-profit, Not-for-profit 
institutions, Federal Government; Number of Respondents: 137,300; Total 
Annual Responses: 6.7 million; Total Annual Hours: 1.53 million.
    5. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Attending 
Physician's Certification of Medical Necessity for Home Oxygen Therapy 
and Supporting Regulations 42 CFR 410.38 and 42 CFR 424.5; Form No.: 
0938-0534 (CMS-484); Use: This form is used to determine if oxygen is 
reasonable and necessary pursuant to Medicare Statute; Medicare claims 
for home oxygen therapy must be supported by the treating physician's 
statement and other information including estimate length of need 
( of months), diagnosis codes (ICD-9) etc.; Frequency: As 
needed; Affected Public: Business of other for-profit; Number of 
Respondents: 175,000; Total Annual Responses: 700,000; Total Annual 
Hours: 116,000.
    6. Type of Information Collection Request: Reinstatement, without 
change, of a previously approved collection; Title of Information 
Collection: Conditions of Coverage for Organ Procurement (OPOs) and 
Supporting Regulations in 42 CFR, Section 486.301-.325); Form No.: CMS-
R-13 (0938-0688); Use: OPOs are required to submit accurate data to CMS 
concerning population and information on donors and organs on an annual 
basis in order to assure maximum effectiveness in the procurement and 
distribution of organs.; Frequency: Annually; Affected Public: Not-for-
profit institutions; Number of Respondents: 59; Total Annual Responses: 
59; Total Annual Hours: 1.
    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

[[Page 14992]]

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: March 20, 2003.
Dawn Willinghan,
Acting, Paperwork Reduction Act Team Leader, CMS Reports Clearance 
Officer, Office of Strategic Operations and Regulatory Affairs, 
Division of Regulations Development and Issuances.
[FR Doc. 03-7305 Filed 3-26-03; 8:45 am]
BILLING CODE 4210-03-P