[Federal Register Volume 69, Number 136 (Friday, July 16, 2004)]
[Notices]
[Page 42745]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-15814]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-379, CMS-116, and CMS-R-215]


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 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.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Clinical 
Laboratory Improvement Amendments Application Form and Supporting 
Regulations in 42 CFR 493.1-.2001; Form No.: CMS-116 (OMB 
0938-0581); Use: Clinical Laboratory Certification--The application 
must be completed by entities performing laboratory testing on human 
specimens for diagnostic or treatment purposes. This information is 
vital to the certification process.; Frequency: Bi-annually; Affected 
Public: Business or other for-profit, not-for-profit institutions, 
Federal Government, and State, Local, or Tribal Government; Number of 
Respondents: 16,000; Total Annual Responses: 16,000; Total Annual 
Hours: 20,000.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Information 
Collection Requirements Referenced in 42 CFR 424.57; Additional DMEPOS 
Supplier Standards; Form No.: CMS-R-215 (OMB 0938-0717); Use: 
Respondents will be suppliers of Durable Medicare Equipment, 
Prosthetics, Orthotics, and Supplies (DMEPOS). CMS needs documentation 
that the DMEPOS supplier has advised beneficiaries that they may either 
rent or purchase inexpensive or routinely purchased equipment and about 
the purchase option for capped rental equipment. This is needed to 
determine if the supplier has met the supplier standards.; Frequency: 
On Occasion and Annually; Affected Public: Business or other for-profit 
and not-for-profit institutions; Number of Respondents: 63,986; Total 
Annual Responses: 35,000; Total Annual Hours: 280,000.
    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://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 30 days of this notice directly to the OMB desk officer: OMB 
Human Resources and Housing Branch, Attention: Christopher Martin, New 
Executive Office Building, Room 10235, Washington, DC 20503.

    Dated: July 2, 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. 04-15814 Filed 7-15-04; 8:45 am]
BILLING CODE 4120-03-P