[Federal Register Volume 68, Number 222 (Tuesday, November 18, 2003)]
[Notices]
[Pages 65072-65073]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-28710]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-901, CMS-2744, CMS-2746]


Agency Information Collection Activities: Submission for OMB 
Review; 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: 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 Entities; 
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: Revision of a currently 
approved collection; Title of Information Collection: End Stage Renal 
Disease Medical Information System ESRD Facility Survey and Supporting 
Regulations in 42 CFR 405.2133; Form No.: CMS-2744 (OMB 0938-
0447); Use: The ESRD Facility Survey form (CMS-2744) is completed 
annually by Medicare-approved providers of dialysis and transplant 
services. The CMS-2744 is designed to collect information concerning 
treatment trends, utilization of services and patterns of practice in 
treating ESRD patients; Frequency: Annually; Affected Public: Business 
or other for-profit, and Not-for-profit institutions; Number of 
Respondents:

[[Page 65073]]

4,360; Total Annual Responses: 4,360; Total Annual Hours: 34,880.
    3. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: End Stage Renal 
Disease Death Notification, P.L. 95-292; 42 CFR 405.2133; 45 CFR 5, 5b; 
20 CFR Parts 401, 422E; Form No.: CMS-2746 (OMB 0938-0448); 
Use: The ESRD Death Notification is to be completed upon the death of 
ESRD patients. Its primary purpose is to collect fact and cause of 
death. Reports of deaths are used to show cause of death and 
demographic characteristics of these patients; Frequency: Other: One-
time (patient death); Affected Public: Business or other for-profit, 
Not-for-profit institutions, and Federal Government; Number of 
Respondents: 4,360; Total Annual Responses: 69,760; Total Annual Hours: 
34,880.
    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 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: November 7, 2003.
Julie Brown,
CMS Reports Clearance Officer, Office of Strategic Operations and 
Strategic Affairs, Division of Regulations Development and Issuances.
[FR Doc. 03-28710 Filed 11-17-03; 8:45 am]
BILLING CODE 4120-03-P