[Federal Register Volume 68, Number 230 (Monday, December 1, 2003)]
[Notices]
[Page 67193]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-29822]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-2728, CMS-2540-96, CMS-1728-94]


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: Revision of a currently 
approved collection.
    Title of Information Collection: End Stage Renal Disease Medical 
Evidence Report Medicare Entitlement and/or Patient Registration and 
Supporting Regulations in 42 CFR 405.2133.
    Form No.: CMS-2728 (OMB 0938-0046).
    Use: This form captures the necessary medical information required 
to determine Medicare eligibility of an end stage renal disease 
claimant. It also captures the specific medical data required for 
research and policy decisions on this population as required by law.
    Frequency: Weekly, Monthly, Quarterly, Semi-annually and Annually.
    Affected Public: Individuals or Households, Business or other for-
profit, Not-for-profit institutions.
    Number of Respondents: 100,000.
    Total Annual Responses: 100,000.
    Total Annual Hours: 75,000.
    2. Type of Information Collection Request: Extension of a currently 
approved collection.
    Title of Information Collection: Skilled Nursing Facility Cost 
Report and Supporting Regulations in 42 CFR 413.20, 413.24, and 
413.106.
    Form No.: CMS-2540-96 (OMB 0938-0463).
    Use: Form CMS-2540-96 is the form used by skilled nursing 
facilities participating in the Medicare program. This form reports the 
health care costs used to determine the amount of reimbursable costs 
for services rendered to Medicare beneficiaries.
    Frequency: Annually.
    Affected Public: Businesses or other for-profit. Not-for-profit 
institutions and State, Local or Tribal Government.
    Number of Respondents: 13,000.
    Total Annual Responses: 13,000.
    Total Annual Hours: 2,480,000.
    3. Type of Information Collection Request: Revision of a currently 
approved collection.
    Title of Information Collection: Home Health Agency Cost Report and 
Supporting Regulations in 42 CFR 413.20, 413.24 and 413.106.
    Form No.: CMS-1728 (OMB No. 0938-0022).
    Use: Participating providers are required to submit annual 
information to CMS in order to achieve settlement of costs for health 
care services rendered to Medicare beneficiaries. The CMS-1728 is the 
form used by Home Health Agencies to report their health care costs to 
determine the amount reimbursable for services furnished to Medicare 
beneficiaries.
    Frequency: Annually.
    Affected Public: Business or other for profit, Not for profit 
institutions, and State, Local or Tribal Gov.
    Number of Respondents: 7,310.
    Total Annual Responses: 7,310.
    Total Annual Hours Requested: 1,311,060.
    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: Melissa Musotto, Room C5-14-03, 7500 Security 
Boulevard, Baltimore, Maryland 21244-1850.

    Dated: November 20, 2003.
Melissa Musotto,
Acting Paperwork Reduction Act Team Leader, Office of Strategic 
Operations and Strategic Affairs, Division of Regulations Development 
and Issuances.
[FR Doc. 03-29822 Filed 11-28-03; 8:45 am]
BILLING CODE 4120-03-P