[Federal Register Volume 71, Number 37 (Friday, February 24, 2006)]
[Notices]
[Pages 9560-9561]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 06-1769]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-1500 (12-90), CMS-1490U, CMS-1490S, CMS-1500 
(08-05)]


Agency Information Collection Activities: Submission for OMB 
Review; 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), 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 function; (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: Health Insurance 
Common Claims Form and Supporting Regulations at 42 CFR part 424, 
subpart C; Form Number: CMS-1500 (12-90), CMS-1490-U, CMS-1490-S 
(OMB: 0938-0008); Use: The Form CMS-1500 answers the needs of 
many health insurers. It is the basic form prescribed by CMS for the 
Medicare program and is only accepted from physicians and suppliers 
that are excluded from the mandatory electronic claims submission 
requirements set forth in the Administrative Simplification Compliance 
Act (ASCA) Public Law 107-105 and the implementing regulation at 42 CFR 
424.32. The Medicaid State Agencies, CHAMPUS/TriCare, Office of 
Workers' Compensation Programs (OWCP), U.S. Railroad Retirement Board 
(RRB), Blue Cross/Blue Shield Plans, the Federal Employees Health 
Benefit Plan, and several private health plans also use it; it is the 
de facto standard ``professional'' claim form. CMS is seeking re-
approval of the CMS-1500 (12/90), CMS-1490-U, and the CMS-1490-S 
forms.; Frequency: Reporting--On occasion; Affected Public: State, 
Local, or Tribal Government, Business or other-for-profit, Not-for-
profit institutions; Number of Respondents: 902,378; Total Annual 
Responses: 957,204,707; Total Annual Hours: 46,383,364.
    2. Type of Information Collection Request: New collection; Title of 
Information Collection: Health Insurance Common Claims Form and 
Supporting Regulations at 42 CFR part 424, subpart C; Form Number: CMS-
1500 (08-05), CMS-1490-S (OMB: 0938-NEW); Use: CMS is 
simultaneously seeking approval for form CMS-1500 (08-05) and the CMS-
1500 (12-90). A concurrent approval for the two forms is needed to 
allow the industry to prepare for the conversion, i.e. computer system 
conversions and mass printing of the form CMS-1500 (08-05). The CMS-
1500 (08-05) will be accepted beginning in October, 2006. Its use will 
be mandatory in 2007. In 2007, the CMS-1500 (12-90) and the 
corresponding OMB control number will be discontinued. The Form CMS-
1500 answers the needs of many health insurers. It is the basic form 
prescribed by CMS for the Medicare program and is only accepted from 
physicians and suppliers that are excluded from the mandatory 
electronic claims submission requirements set forth in the 
Administrative Simplification Compliance Act (ASCA) Public Law 107-105 
and the implementing regulation at 42 CFR 424.32. The Medicaid State 
Agencies, CHAMPUS/TriCare, Office of Workers' Compensation Programs 
(OWCP), U.S. Railroad Retirement Board (RRB), Blue Cross/Blue Shield 
Plans, the Federal

[[Page 9561]]

Employees Health Benefit Plan, and several private health plans also 
use it; it is the de facto standard ``professional'' claim form.; 
Frequency: Reporting--On occasion; Affected Public: State, Local, or 
Tribal Government, Business or other-for-profit, Not-for-profit 
institutions; Number of Respondents: 902,378; Total Annual Responses: 
957,204,707; Total Annual Hours: 46,383,364.
    To obtain copies of the supporting statement and any related forms 
for these paperwork collections referenced above, access CMS Web site 
address at http://www.cms.hhs.gov/PaperworkReductionActof1995, 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.
    To be assured consideration, comments and recommendations for the 
proposed information collections must be received by the OMB Desk 
Officer at the address below, no later than 5 p.m. on March 27, 2006. 
OMB Human Resources and Housing Branch, Attention: Carolyn Lovett, CMS 
Desk Officer, New Executive Office Building, Room 10235, Washington, DC 
20503.

    Dated: February 16, 2006.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 06-1769 Filed 2-23-06; 8:45 am]
BILLING CODE 4120-01-P