[Federal Register Volume 69, Number 175 (Friday, September 10, 2004)]
[Notices]
[Pages 54795-54796]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-20271]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-10106 and CMS-10072]


Agency Information Collection Activities: Submission for OMB 
Review; 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

[[Page 54796]]

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: Medicare Authorization to Disclose Health 
Information; Form No.: CMS-10106 (OMB 0938-NEW; Use: Unless 
permitted or required by law, the Privacy Act and Health Insurance 
Portability and Accountability Act (HIPAA) Privacy Rule prohibit 
covered entities from disclosing an individual's protected health 
information to a third party without a valid privacy authorization. The 
authorization must include specified core elements and certain 
statements. Medicare beneficiaries will use the ``Medicare 
Authorization to Disclose Health Information'' to authorize Medicare to 
disclose their protected health information to a third party; 
Frequency: Other: an event basis; Affected Public: Individuals or 
Households; Number of Respondents: 39,000,000; Total Annual Responses: 
1,000,000; Total Annual Hours: 250,000.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Survey Tool for 
Medicare.gov Web site; Form No.: CMS-10072 (OMB 0938-0900); 
Use: CMS has developed a survey tool using MSInteractive to obtain 
feedback from users accessing cms.hhs.gov Web site to guide future 
improvements; Frequency: On Occasion; Affected Public: Individuals or 
Households and Business or other for-profit; Number of Respondents: 
7,000; Total Annual Responses: 7,000; Total Annual Hours: 583.
    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: August 31, 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. 04-20271 Filed 9-9-04; 8:45 am]
BILLING CODE 4120-03-P