[Federal Register Volume 69, Number 208 (Thursday, October 28, 2004)]
[Notices]
[Pages 62900-62901]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-24077]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-10113]


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 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: Revision of currently 
approved collection; Title of Information Collection: Application for 
Participation in Medicare Replacement Drug Demonstration; 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: Other: Once 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.hhs.gov/

[[Page 62901]]

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: October 21, 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. 04-24077 Filed 10-27-04; 8:45 am]
BILLING CODE 4120-03-P