[Federal Register Volume 69, Number 175 (Friday, September 10, 2004)]
[Notices]
[Page 54795]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-20270]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-10052, CMS-370, 377, 378, R-54, and CMS-R-
218]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare and Medicaid Services.
    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: Revision of currently 
approved collection;
    Title of Information Collection: Recognition of Pass-Through 
Payment for Additional (new) Categories of Devices under the Outpatient 
Prospective Payment System and Supporting Regulations in 42 CFR Part 
419; Use: Information is necessary to determine eligibility of medical 
devices for establishment of additional device categories for payment 
under transitional pass-through payment provisions as required by 
section 1833(t) (6) of the Social Security Act. Form Number: CMS-10052 
(OMB: 0938-0857); Frequency: On occasion; Affected Public: 
Business or other for-profit; Number of Respondents: 12; Total Annual 
Responses: 12; Total Annual Hours: 192.
    2. Type of Information Collection Request: Revision of currently 
approved collection;
    Title of Information Collection: Ambulatory Surgical Center (ASC) 
Health Insurance Benefit Agreement, ASC Request for Certification, ASC 
Survey Report and Supporting Regulations in 42 CFR 416.41, 416.43, 
416.47, and 416.48; Use: The ASC Health Insurance Benefits Agreement 
form is utilized for the purpose of establishing eligibility for 
payment under Title XVIII of the Social Security Act. The ASC Request 
for Certification form is utilized as an application for facilities 
wishing to participate in the Medicare program as an ASC. This form 
initiates the process of obtaining a decision as to whether the 
conditions of coverage are met. It also promotes data retrieval from 
the Online Data Input Edit (ODIE system, a subsystem of the Online 
Survey Certification and Report (OSCAR) system by the Centers for 
Medicare and Medicaid Services (CMS) Regional Offices (RO)). The ASC 
Report Form is an instrument used by the State survey agency to record 
data collection in order to determine supplier compliance with 
individual conditions of coverage and to report it to the Federal 
government. The form is primarily a coding worksheet designed to 
facilitate data reduction and retrieval into the ODIE/OSCAR system at 
the CMS ROs. This form includes basic information on compliance (i.e., 
met, not met and explanatory statements) and does not require any 
descriptive information regarding the survey activity itself; Form 
Number: CMS-370, 377, 378, R-54 (OMB: 0938-0266); Frequency: 
Annually and other: once; Affected Public: State, local or tribal 
government; Number of Respondents: 4,312; Total Annual Responses: 
4,312; Total Annual Hours: 2,241.
    3. Type of Information Collection Request: Extension of currently 
approved collection; Title of Information Collection: ICRS Contained in 
45 CFR Part 162; HIPAA Standards for Electronic Transactions; Use: This 
submission contains information collection requirements in HCFA-0149-F, 
CMS-0003-P, CMS-0005-P, and CMS-003/005-F. This collection establishes 
standards for electronic transactions and for code sets to be used in 
those transactions. The collection standardizes the approximately 400 
formats of electronic health care claims used in the United States. The 
use of these standards significantly reduces the administrative burden 
associated with paper documents, lowers operating costs, and improves 
data quality for health care providers and health plans; Form Number: 
CMS-R-218 (OMB 0938-0866); Frequency: On occasion; Affected 
Public: Business or other for-profit; Number of Respondents: 3.4 
million; Total Annual Responses: 3.4 million; Total Annual Hours: 1 
hour.
    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 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: August 31, 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. 04-20270 Filed 9-9-04; 8:45 am]
BILLING CODE 4120-03-P