[Federal Register Volume 70, Number 82 (Friday, April 29, 2005)]
[Notices]
[Page 22317]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-8713]



[[Page 22317]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10117, 10118, 10119, 10135, 10136 and CMS-R-
138]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & 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 & Medicaid 
Services (CMS) 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: Medicare 
Advantage Application for Coordinated Care, Private Fee-for-Service, 
Regional Preferred Provider Organization, Service Area Expansion for 
Coordinated Care and Private Fee-for-Service Plans, Medical Savings 
Account Plans; Form Nos.: CMS-10117, 10118, 10119, 10135, 10136 (OMB 
 0938-0935); Use: Health plans must meet certain regulatory 
requirements to enter into a contract with CMS to provide health 
benefits to Medicare beneficiaries. These applications are the 
collection forms to obtain the information from a health plan that will 
allow CMS staff to determine compliance with the regulations; 
Frequency: Other--one-time submission; Affected Public: Business or 
other for-profit, Not-for-profit institutions, and State, Local or 
Tribal Government; Number of Respondents: 420; Total Annual Responses: 
520; Total Annual Hours: 20,100.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare 
Geographic Classification Review Board (MGCRB) Procedures and 
Supporting Regulations in 42 CFR Sections 412.256 and 412.230; Form 
Nos.: CMS-R-138 (OMB 0938-0573); Use: Section 1886(d)(10) of 
the Social Security Act established the Medicare Geographic 
Classification Review Board (MGCRB), an entity with the authority to 
accept short-term hospital inpatient prospective payment system 
applications from hospitals requesting geographic reclassification for 
wage index or standardized payment amounts and to issue decisions on 
these requests. This regulation sets up the application process for 
prospective payment system hospitals that choose to appeal their 
geographic status to the MGCRB. This regulation also establishes 
procedural guidelines for the MGCRB; Frequency: Reporting--Annually; 
Affected Public: Business or other for-profit, Not-for-profit 
institutions; Number of Respondents: 500; Total Annual Responses: 500; 
Total Annual Hours: 500.
    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 60 days of this notice to the address 
below:CMS, Office of Strategic Operations and Regulatory Affairs, 
Division of Regulations Development,Attention: Melissa Musotto, PRA 
Specialist,Room C4-26-05,7500 Security Boulevard,Baltimore, Maryland 
21244-1850.

    Dated: April 22, 2005.
Michelle Shortt,
Acting Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 05-8713 Filed 4-28-05; 8:45 am]
BILLING CODE 4120-01-P