[Federal Register Volume 68, Number 149 (Monday, August 4, 2003)]
[Notices]
[Pages 45825-45826]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-19698]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-255, CMS-R-199]


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.
    Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Municipal Health 
Services Cost Report Form and supporting Regulations 42 CFR 405.2470; 
Form No.: CMS-255 (OMB 0938-0155); Use: The Municipal Health 
Services Program Cost Report (CMS 255) is used by the participating 
clinics to report costs for health care services rendered to Medicare 
beneficiaries. It is

[[Page 45826]]

also used to gather data to properly evaluate the demonstration; 
Frequency: Annually; Affected Public: Not-for-profit institutions; 
Number of Respondents: 14; Total Annual Responses: 14; Total Annual 
Hours: 476.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicaid Report 
on Payables and Receivables; Form No.: CMS-R-199 (OMB 0938-
0697); Use: The Chief Financial Officers Act of 1990 requires 
government agencies to produce auditable financial statements. This 
form will collect accounting data from the States on Payables and 
Receivables; Frequency: Annually; Affected Public: State, Local or 
Tribal Government; Number of Respondents: 57; Total Annual Responses: 
57; Total Annual Hours: 342.
    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: July 28, 2003.
Julie Brown,
Acting CMS Reports Clearance Officer, Division of Regulations 
Development and Issuances, Office of Strategic Operations and Strategic 
Affairs.
[FR Doc. 03-19698 Filed 8-1-03; 8:45 am]
BILLING CODE 4120-03-P