[Federal Register Volume 69, Number 64 (Friday, April 2, 2004)]
[Notices]
[Page 17418]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-7421]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-R-290 and CMS-379]


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: Extension of a currently 
approved collection; Title of Information Collection: Medicare Program: 
Process for Making National Coverage Determinations; Form No.: CMS-R-
290 (OMB 0938-0776); Use: These information collection 
requirements provide the process CMS uses to make a national coverage 
decision for a specific item or service under sections 1862 and 1871 of 
the Social Security Act. This streamlines our decision making process 
and increases the opportunities for public participation in making 
national coverage decisions.; Frequency: Other: as needed; Affected 
Public: Business or other for-profit, not-for-profit institutions; 
Number of Respondents: 200; Total Annual Responses: 200; Total Annual 
Hours: 8,000.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: The Financial 
Statement of Debtor and Supporting Regulations in 42 CF Section 
405.376; Form No.: CMS-379 (OMB 0938-0270); Use: This form is 
used to collect financial information which is needed to evaluate 
requests from physicians/suppliers to pay indebtedness under an 
extended repayment schedule, or to compromise a debt less than the full 
amount; Frequency: Other: as needed; Affected Public: Business or other 
for-profit, individuals or households; Number of Respondents: 500; 
Total Annual Responses: 500; Total Annual Hours: 1,000.
    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: March 25, 2004.
John P. Burke, III,
Paperwork Reduction Act Team Leader, Office of Strategic Operations and 
Strategic Affairs, Division of Regulations Development and Issuances.
[FR Doc. 04-7421 Filed 4-1-04; 8:45 am]
BILLING CODE 4120-03-P