[Federal Register Volume 69, Number 73 (Thursday, April 15, 2004)]
[Notices]
[Pages 20011-20012]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-8531]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-250-254 and CMS-1964]


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 Request: Extension of a currently approved 
collection.
    Title of Information Collection: Medicare Secondary Payer 
Information Collection and Supporting Regulations in 42 CFR 411.25, 
489.2, and 489.20.
    Form Number: CMS-250 through CMS-254 (OMB 0938-0214).
    Use: Medicare Secondary Payer (MSP) is essentially the same concept 
known in the private insurance industry as coordination of benefits and 
refers to those situations where Medicare does not have primary 
responsibility for paying the medical expenses of a Medicare 
beneficiary. Medicare intermediaries and carriers must collect 
information to perform various tasks to detect and process MSP cases.
    Frequency: On occasion and Other: One time.
    Affected Public: Individuals or households, Business or other for-
profit, and not-for-profit institutions.
    Number of Respondents: 134,553,682.
    Total Annual Responses: 134,553,682;
    Total Annual Hours Requested: 1,114,839.
    2. Type of Information Collection Request: Revision of a currently 
approved collection.
    Title of Information Collection: Request for Review of Part B 
Medicare Claim and Supporting Regulations in 42 CFR 405.807.
    Form No.: CMS-1964 (OMB 0938-0033).
    Use: This form is the preferred manner to enable appellants to 
request a Part B review by a carrier.
    Frequency: Other: as needed.
    Affected Public: Individuals or Households, and not-for-profit 
institutions.
    Number of Respondents: 6,860,000.
    Total Annual Responses: 6,860,000.
    Total Annual Hours: 1,715,000.
    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,

[[Page 20012]]

Attention: Brenda Aguilar, New Executive Office Building, Room 10235, 
Washington, DC 20503.

    Dated: April 8, 2004.
John P. Burke, III,
Paperwork Reduction Act Team Leader, CMS Reports Clearance Officer, 
Office of Strategic Operations and Regulatory Affairs, Division of 
Regulations Development and Issuances.
[FR Doc. 04-8531 Filed 4-14-04; 8:45 am]
BILLING CODE 4120-03-P