[Federal Register Volume 69, Number 115 (Wednesday, June 16, 2004)]
[Notices]
[Pages 33642-33643]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-13505]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-10111 and CMS-R-263]


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: New Collection; Title of 
Information Collection: Notice of Exclusions from Medicare Benefits-
Home Health Agency and Supporting Regulations in 42 CFR 484.10; Form 
No.: CMS-10111 (OMB 0938-NEW); Use: Whenever a Home Health 
Agency reduces or terminates home health services, the home health 
agency must give notice; Affected Public: Business or other for-profit, 
Individuals or

[[Page 33643]]

Households, and Not-for-profit institutions; Number of Respondents: 
6,813; Total Annual Responses: 534,295; Total Annual Hours: 534,429.5.
    2. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: On-site 
Inspection for Durable Medicare Equipment (DME) Supplier Location and 
Supporting Regulations in 42 CFR, Section 424.57; Form No.: CMS-R-263 
(OMB 0938-0749); Use: CMS collects information on any supplier 
who submits bills to Medicare or who applies for a Medicare Billing 
Number before allowing the supplier to enroll. This information must 
minimally clearly identify the provider and its place of business as 
required in Pub. L. 99-272 Section 9202(g) and provide all necessary 
documentation to prove that they are qualified to perform the services 
for which they are billing. The on-site inspection for Durable Medical 
Equipment (DME) Supplier Location verifies this information; Affected 
Public: Business or other for-profit, Not-for-profit institutions, and 
State, Local, or Tribal Gov.; Number of Respondents: 20,000; Total 
Annual Responses: 20,000; Total Annual Hours: 10,000.
    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://www.cms.hhs.gov/regulations/pra/, 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: June 8, 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. 04-13505 Filed 6-15-04; 8:45 am]
BILLING CODE 4120-03-P