[Federal Register Volume 69, Number 160 (Thursday, August 19, 2004)]
[Notices]
[Pages 51467-51468]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-19017]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-10113]


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.
    Type of Information Collection Request: Extension of currently 
approved collection.
    Title of Information Collection: Application for Participation in 
Medicare Replacement Drug Demonstration.

[[Page 51468]]

    Use: Section 641 of the MMA mandated a demonstration that would pay 
for drugs/biologicals prescribed as replacements for existing covered 
Medicare drugs. A report to Congress evaluating the impact of this 
demonstration was also mandated. In order to enroll in this 
demonstration, a beneficiary will be required to submit the application 
forms. Beneficiaries who wish to be considered for a low-income subsidy 
must also provide the information on the ``Application for Financial 
Assistance.''
    Form Number: CMS-10113
    OMB#: 0938-0924.
    Frequency: One per beneficiary.
    Affected Public: Individuals or Households.
    Number of Respondents: 50,000.
    Total Annual Responses: 50,000.
    Total Annual Hours: 20,417.
    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.gov/regs/prdact95.htm, 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 at (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: Pam 
Gulliver, CMS-10113, Room C5-10-06, 7500 Security Boulevard, Baltimore, 
Maryland 21244-1850.

    Dated: August 12, 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. 04-19017 Filed 8-18-04; 8:45 am]
BILLING CODE 4120-03-P