[Federal Register Volume 69, Number 20 (Friday, January 30, 2004)]
[Notices]
[Page 4521]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-1984]



[[Page 4521]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-10101, CMS-10093, CMS-304&304a, CMS-565, and 
CMS-R-246]


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

AGENCY: Centers for Medicare and Medicaid Services.
    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: Survey of Medicare Preferred Provider 
Organization Demonstration Form No.: CMS-10101 (OMB 0938-NEW); 
Use: This information collection will be used to collect information 
from Medicare Beneficiaries to understand beneficiary experiences with 
the new managed care option and to understand which Medicare 
beneficiaries are attracted to the PPO model and why. CMS also wants to 
know what both enrollees and non-enrollees in PPOs know and understand 
about this new option; Frequency: Other: One-time Only; Affected 
Public: Individuals or Households; Number of Respondents: 38,216; Total 
Annual Responses: 38,216; Total Annual Hours: 9,556.
    2. Type of Information Request: Extension of a currently approved 
collection; Type of Information Collection: CMS/AoA Aging and 
Disability Resource Center Grant Program; CMS Form Number: CMS-10093 
(OMB 0938-0903); Use: Information sought by CMSO/DEHPG is 
needed to award competitive grants to States to develop Aging and 
Disability Resource Centers; Frequency: Semi-annually; Affected Public: 
State, local, or tribal government, Not-for-profit institutions, 
Business or other for-profit; Number of Respondents: 24; Total Annual 
Responses: 48; Total Annual Burden Hours: 960.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicaid Drug 
Rebate; Form No.: CMS-304 and CMS-304a (OMB 0938-0676); Use: Section 
1927 of the Social Security Act requires State Medicaid agencies to 
report to drug manufacturers and CMS on the drug utilization for their 
State and the amount of rebate to be paid by the manufacturer; 
Frequency: Quarterly; Affected Public: State, local, or tribal 
government; Number of Respondents: 51; Total Annual Responses: 204; 
Total Annual Hours: 6,125.
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare 
Qualification Statement for Federal Employees and Supporting 
Regulations in 42 CFR 406.15; Form No.: CMS-565 (OMB 0938-
0501); Use: The CMS-565 is completed by individuals filing for hospital 
insurance ([HI] Part A) benefits based upon their federal employment. 
This information is needed to determine if SSA/CMS can use (deem) 
federal employment prior to 1983 to provide quarters of coverage so the 
individual can qualify for free hospital insurance; Frequency: Other: 
One-time-only; Affected Public: Individuals or Households, Federal 
Government, State, Local, or Tribal Government; Number of Respondents: 
4,300; Total Annual Responses: 4,300; Total Annual Hours: 717.
    5. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare Consumer 
Assessment of Health Plan Survey--Medicare + Choice (CAHPS-M+C); Form 
No.: CMS-R-246(OMB 0938-0732); Use: Under the Balanced Budget 
Act of 1997, CMS is required to provide general and plan comparative 
information to beneficiaries that will help them make more informed 
health plan choices. A CAHPS fee-for-service survey is needed to 
provide information comparable to those data collected from the CAHPS 
managed care survey; Frequency: Annually; Affected Public: Individuals 
or Households; Number of Respondents: 168,000; Total Annual Responses: 
168,000; Total Annual Hours: 55,450.
    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: January 22, 2004.
Melissa Musotto,
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. 04-1984 Filed 1-29-04; 8:45 am]
BILLING CODE 4120-03-P