[Federal Register Volume 69, Number 69 (Friday, April 9, 2004)]
[Notices]
[Page 18912]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-8095]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-R-131]


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: Extension of a currently 
approved collection; Title of Information Collection: Advanced 
Beneficiary Notice and Supporting Regulations in 42 CFR 411.404, 
411.406, and 411.408; Form No.: CMS-R-131 (OMB 0938-0566); 
Use: Physicians, practitioners, suppliers, and providers furnishing 
Part A or Part B items or services may bill a patient for items of 
services denied by Medicare as not reasonable and necessary, under 
Medicare program standards (section 1862(a)(1) of title XVIII of the 
Social Security Act (the Act), or under one of several other statutory 
bases (section 1862(a)(9), section 1814(a)(2)(C), section 
1835(a)(2)(A), section 1861(dd)(3)(A), section 1834(j)(1), section 
1834(a)(15), and section 1834(a)(17)(B) of the Act), if they informed 
the patient , prior to furnishing the items or services and the 
patient, after being so informed, agreed to pay for the items or 
services; Frequency: As-needed; Affected Public: Business or other for-
profit, not-for-profit institutions, and individuals or households; 
Number of Respondents: 1,084,932; Total Annual Responses: 21,171,480; 
Total Annual Hours: 1,764,290.
    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: April 1, 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. 04-8095 Filed 4-8-04; 8:45 am]
BILLING CODE 4120-03-P