[Federal Register Volume 69, Number 48 (Thursday, March 11, 2004)]
[Notices]
[Pages 11635-11636]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-5412]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-10003, CMS-2728, and CMS-R-39]


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: Extension of a currently 
approved collection; Title of Information Collection: Medicare+Choice 
Appeals Notices, ``Notice of Denial of Medical Coverage'', ``Notice of 
Denial Payment'; Form No.: CMS-10003 (OMB 0938-0829); Use: 
Section 1852(g)(1)(B) requires M+C organizations to provide 
determinations to deny coverage (i.e., medical services or payment) in 
writing and include a statement in understandable language of the 
reasons for the denial and a

[[Page 11636]]

description of the reconsideration and appeals processes. These notices 
fulfill the statutory requirement.; Frequency: On occasion and other: 
distribution; Affected Public: Individuals or households, business or 
other for-profit, not-for-profit institutions; Number of Respondents: 
211; Total Annual Responses: 71,200; Total Annual Hours: 7,120.
    2. 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.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Home health 
Medicare Conditions of Participation (CoP) Information Collection 
Requirements and Supporting Regulations in 42 CFR 484.10, 484.12, 
484.14, 484.16, 484.18, 484.36, 484.48, and 484.52; Form No.: CMS-R-39 
(OMB 0938-0365); Use: 42 CFR part 484 outlines Home Health 
Agency Medicare CoP to ensure HHAs meet the Federal patient health and 
safety regulations; Frequency: Annually; Affected Public: Business or 
other for-profit, not-for-profit institutions, Federal government, and 
State, local or tribal government; Number of Respondents: 7,422; Total 
Annual Responses: 7,422; Total Annual Hours: 854,891.
    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; Fax 
(202)395-6929.

    Dated: March 4, 2004.
John P. Burke, III,
Paperwork Reduction Act Team Leader, CMS Reports Clearance Officer, 
Office of Strategic Operations and Strategic Affairs, Division of 
Regulations Development and Issuances.
[FR Doc. 04-5412 Filed 3-10-04; 8:45 am]
BILLING CODE 4120-03-P