[Federal Register Volume 68, Number 80 (Friday, April 25, 2003)]
[Notices]
[Page 20391]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-10245]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-1514, CMS-643, CMS-462A-B, CMS-588]


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 (CMS)), 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: Hospital Request for Certification 
in the Medicare/Medicaid Program.
    Form No.: CMS-1514 (OMB 0938-0380).
    Use: Section 1861 of the Social Security Act requires hospitals and 
critical access hospitals to be certified to participate in the 
Medicare/Medicaid program. These providers must complete the ``Hospital 
Request for Certification in the Medicare/Medicaid Program'' form in 
order to be certified or recertified.
    Frequency: Annually.
    Affected Public: Business or other for-profit, Not-for-profit 
institutions.
    Number of Respondents: 6,300.
    Total Annual Responses: 2,000.
    Total Annual Hours: 500.
    2. Type of Information Collection Request: Extension of a currently 
approved request.
    Title of Information Collection: Hospice Survey and Deficiencies 
Report Form and Supporting Regulations at 42 CFR 418.1--418.405.
    Form No.: CMS-643 (OMB 0938-0379).
    Use: In order to participate in the Medicare program, a hospice 
must meet certain Federal health and safety conditions of 
participation. This form will be used by State surveyors to record data 
about a hospice's compliance with these conditions of participation in 
order to initiate the certification or recertification process.
    Frequency: Annually.
    Affected Public: State, local or tribal government.
    Number of Respondents: 2,339.
    Total Annual Responses: 475.
    Total Annual Hours: 1,188.
    3. Type of Information Collection Request: Extension of a currently 
approved collection.
    Title of Information Collection: Clinical Laboratory Improvement 
Amendments (CLIA) Adverse Action Extract and Supporting Regulations at 
42 CFR 483.1840.
    Form No.: CMS-462A/B (OMB 0938-0655).
    Use: The CLIA Adverse Action Extract will be used by CMS surveyors 
(State health department, and other CMS agents) to report to regional 
staff and record the adverse actions imposed against a laboratory. The 
form will also serve to track dates of the imposition of adverse 
actions, date on which a laboratory corrects deficiencies, and all 
appeals activity.
    Frequency: On occasion, Biennially.
    Affected Public: State, local, or tribal government.
    Number of Respondents: 52.
    Total Annual Responses: 1573.
    Total Annual Hours: 786.
    4. Type of Information Collection Request: Revision of a currently 
approved collection.
    Title of Information Collection: Authorization agreement for 
electronic forms transfer.
    Form No.: CMS-0588 (OMB 0938-0626).
    Use: The information is needed to allow providers to receive funds 
electronically in their bank accounts.
    Frequency: On occasion.
    Affected Public: Business or other for-profit, Not-for-profit 
institutions.
    Number of Respondents: 10,000.
    Total Annual Responses: 10,000.
    Total Annual Hours: 1,250.
    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 17, 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. 03-10245 Filed 4-24-03; 8:45 am]
BILLING CODE 4120-03-P