[Federal Register Volume 68, Number 72 (Tuesday, April 15, 2003)]
[Notices]
[Page 18212]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-9115]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-10087, CMS-2384, CMS-10006]


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: New collection; Title of 
Information Collection: Evaluation of the Illinois and Wisconsin State 
Pharmacy Assistance Waivers; Form No.: CMS-10087 (OMB 0938-
NEW); Use: CMS has implemented the Pharmacy Plus Initiative to grant 
waivers to states to provide pharmacy benefits to low-income elders 
with incomes too high to qualify for Medicaid. This study will evaluate 
the Pharmacy Plus programs initiated in the states of Illinois and 
Wisconsin using a variety of methods including a descriptive program 
evaluation, survey of participants, analyses of drug utilization and 
costs as well as the cost impact to the Medicare and Medicaid programs; 
Frequency: Other: one-time only; Affected Public: Individuals or 
Households; Number of Respondents: 2,200; Total Annual Responses: 
2,200; Total Annual Hours: 550.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Third Party 
Premium Billing Request; Form No.: CMS-2384; Use: The Third Party 
Premium Billing Request is used as an authorization to designate that a 
family member or other interested party receive the Medicare Premium 
Bill and pay it on behalf of a Medicare beneficiary. Frequency: On 
occasion; Affected Public: Individuals or households; Number of 
Respondents: 15,000; Total Annual Hours: 6,250.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: TWWIIA 
Demonstration to Maintain Independence; Form No.: CMS-10006 
(OMB 0938-0799); Use: Section 204 of the Ticket to Work and 
Work Incentives Act provides for the establishment of grants for states 
that develop and implement demonstration programs designed to support 
working people with physical or mental impairments that without medical 
assistance will result in disability. State agencies will be applying 
for these grants; Frequency: Annually; Affected Public: State, Local, 
or Tribal government; Number of Respondents: 56; Total Annual 
Responses: 56; Total Annual Hours: 5,600.
    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: C5-14-03, 7500 
Security Boulevard, Baltimore, Maryland 21244-1850.

    Dated: April 3, 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. 03-9115 Filed 4-14-03; 8:45 am]
BILLING CODE 4120-03-P