[Federal Register Volume 69, Number 94 (Friday, May 14, 2004)]
[Notices]
[Page 26841]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-10988]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-R-214, CMS-179, CMS-367, 367-A, 367-C and 
CMS-417]


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

AGENCY: Centers for Medicare & 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 & 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: Independent 
Diagnostic Testing Facility and Supporting Regulations contained in 42 
CFR 410.33; Form No.: CMS-R-214 (OMB 0938-0721); Use: The 
information collection requirements associated with an Independent 
Diagnostic Testing Facilities involve documentation of proficiency of 
medical personnel and of resources; Frequency: Annually; Affected 
Public: Business or other for-profit, Federal Government and State, 
local and tribal government; Number of Respondents: 500; Total Annual 
Responses: 500; Total Annual Hours: 42.
    2. Type of Information Request: Extension of a currently approved 
collection; Title of Information Collection: Transmittal and Notice of 
Approval of State Plan Material and Supporting Regulations in 42 CFR 
430.10-430.20 and 440.167; Form Number: CMS-179 (OMB approval 
: 0938-0193); Use: Form CMS-179 is used by State agencies to 
transmit State plan material to CMS for approval prior to amending 
their State plans; Frequency: On occasion; Affected Public: State, 
local or tribal gov't; Number of Respondents: 56; Total Annual 
Responses: 56; Total Annual Hours Requested: 560.
    3. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Medicaid Drug 
Rebate Program--Manufacturers; Form No.: 0938-0578 (CMS-367, 367a, and 
367c); Use: Section 1927 requires drug manufacturers to enter into and 
have in effect a rebate agreement with the Federal Government for 
States to receive funding for drugs dispensed to Medicaid recipients; 
Frequency: Quarterly; Affected Public: Business or other for-profit; 
Number of Respondents: 570; Total Annual Responses: 2,280; Total Annual 
Hours: 54,780.
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Hospice Request 
for Certification in the Medicare Program; Form No.: CMS-417 
(OMB 0938-0313); Use: The Hospice Request for Certification 
Form is used for hospice identification, screening, and to initiate the 
certification process. The information captured on this form is entered 
into a data base which assists CMS in determining whether providers 
have sufficient personnel to participate in the Medicare program; 
Frequency: Annually; Affected Public: Business or other for-profit, 
Not-for-profit institutions, Federal Government, and State, local or 
tribal government; Number of Respondents: 2,286; Total Annual 
Responses: 2,286; Total Annual Hours: 572.
    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: May 6, 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. 04-10988 Filed 5-13-04; 8:45 am]
BILLING CODE 4120-03-P