[Federal Register Volume 68, Number 59 (Thursday, March 27, 2003)]
[Notices]
[Page 14992]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-7306]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-901 and CMS-3070]


Agency Information Collection Activities: Proposed Collection; 
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: Revision of a currently 
approved collection; Title of Information Collection: Qualification 
Application: Medicare+Choice Application for HMOs, PPOs, and State 
Licensed PSOs; Medicare+Choice Application for Federally Waived PSOs; 
Medicare+Choice Application for Medicare Savings Account Entitities; 
Medicare+Choice Application for Private Fee-for-Service Plans.; Form 
No.: CMS-901 (OMB 0938-0470); Use: Prepaid health plans must 
meet certain regulatory requirements to be federally qualified health 
maintenance organizations or to enter into a contract with CMS to 
provide health benefits to Medicare beneficiaries. The application is 
the collection form to obtain the information from a health plan that 
will allow CMS staff to determine compliance with the regulations.; 
Frequency: Other: One-time submission.; Affected Public: Business or 
other for-profit, Not-for-profit institutions, State, Local or Tribal 
Government; Number of Respondents: 55; Total Annual Responses: 55; 
Total Annual Hours: 5,500.
    2. Type of Information Collection Request: Extension of a 
previously approved collection; Title of Information Collection: 
Intermediate Care Facility for the Mentally Retarded or Persons with 
Related Conditions ICF/MR Survey Report Form (3070G-I) and Supporting 
Regulations at 42CFR 431.52, 431.151, 435.1009, 440.150, 440.220, 
442.1, 442.10-442.16, 442 .30, 442.40, 442.42, 442.100-442.119, 
483.400-483.480, 488.332, 488.400, and 498.3-498.5; Form No.: CMS-3070 
(0938-0062); Use: The survey forms are needed to ensure provider 
compliance. In order to participate in the Medicaid program as an ICF/
MR, a providers must meet Federal standards. The survey report form is 
used to record providers' level of compliance with the individual 
standard and report it to the Federal government. We are considering 
revising this collection to properly reflect the burden imposed by 
implementing regulations; Frequency: Annually; Affected Public: 
Business or other for-profit, Not-for-profit institutions; Number of 
Respondents: 6,763; Total Annual Responses: 6,763; Total Annual Hours: 
21,600.
    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: March 20, 2003.
Dawn Willinghan,
Acting, Paperwork Reduction Act Team Leader, CMS Reports Clearance 
Officer, Office of Strategic Operations and Strategic Affairs, Division 
of Regulations Development and Issuances.
[FR Doc. 03-7306 Filed 3-26-03; 8:45 am]
BILLING CODE 4120-03-P