[Federal Register Volume 71, Number 111 (Friday, June 9, 2006)]
[Notices]
[Pages 33457-33458]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E6-8748]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10069, CMS-10137, CMS-1763 and CMS-10080]


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

[[Page 33458]]

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: Medicare Waiver 
Demonstration Application; Use: The Medicare Waiver Demonstration 
Application will be used to collect standard information needed to 
implement congressionally mandated and administration priority 
demonstrations. The application will be used to gather information 
about the characteristics of the applicant's organization, benefits, 
and services they propose to offer, success in operating the model, and 
evidence that the model is likely to be successful in the Medicare 
program. The standard application will be used for all waiver 
demonstrations and will reduce the burden on applicants, provide for 
consistent and timely information collections across demonstrations, 
and provide a user-friendly format for respondents; Form Number: CMS-
10069 (OMB: 0938-0880); Frequency: Reporting--On Occasion; 
Affected Public: Business or other for-profit, not-for-profit 
institutions; Number of Respondents: 75; Total Annual Responses: 75; 
Total Annual Hours: 6000.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Application for 
Prescription Drug Plans (PDP); Application for Medicare Advantage 
Prescription Drug (MA-PD) Plans; Application for Cost Plans to Offer 
Qualified Prescription Drug Coverage; Application for PACE Organization 
to Offer Qualified Prescription Drug Coverage; Application for Employer 
Group Waiver Plans to Offer Prescription Drug Coverage; Service Area 
Expansion Application to Offer Prescription Drug Coverage in a New 
Region; Use: Coverage for the prescription drug benefit will be 
provided through contracted prescription drug plans (PDPs) or through 
Medicare Advantage (MA) plans that offer integrated prescription drug 
and health care coverage (MA-PD plans). Cost Plans that are regulated 
under Section 1876 of the Social Security Act, Employer Group Waiver 
Plans (EGWP) and PACE plans may also provide a Part D benefit. 
Organizations wishing to provide services under the Prescription Drug 
Benefit Program must complete an application, negotiate rates, and 
receive final approval from CMS. Existing Part D Sponsors may also 
expand their contracted service area by completing the Service Area 
Expansion (SAE) application; Form Number: CMS-10137 (OMB: 
0938-0936); Frequency: Reporting--Other--depending on programs area and 
data requirements;
    Affected Public: Business or other for-profit, not-for-profit 
institutions, Federal government; Number of Respondents: 101; Total 
Annual Responses: 101; Total Annual Hours: 3,828.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Request for 
Termination of Premium Hospital and/or Supplementary Medical Insurance 
and Supporting Regulations in 42 CFR 406.28 & 407.27; Use: Under 42 CFR 
406.28 (a) and 407.27 (c) a Medicare beneficiary, wishing to 
voluntarily terminate enrollment in Medicare Supplementary Medical 
Insurance and/or Premium-Hospital Insurance can file a written request 
with CMS or the Social Security Administration. The form, Request for 
Termination of Premium Hospital and/or Supplementary Medical Insurance, 
was developed to comply with these requirements. Form Number: CMS-1763 
(OMB: 0938-0025); Frequency: Reporting: Other: One Time Only; 
Affected Public: Individuals or households, Federal, State, Local or 
Tribal Government; Number of Respondents: 14,000;
    Total Annual Responses: 14,000; Total Annual Hours: 5,833.
    4. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Publications Use 
Study; Use: The Balanced Budget Act (BBA) of 1997 increased the number 
and type of health insurance options available to Medicare 
beneficiaries and implemented new preventative health care benefits. 
The BBA also gave CMS a greater responsibility to help Medicare 
beneficiaries better understand these increased health care options and 
benefits. This research is designed to strengthen the information 
dissemination efforts by CMS to meet beneficiaries' needs. The current 
study expands on previous methodology to include surveys of not only 
print-based publications but of Web-based publications as well. CMS is 
mandated to provide a range of information about Medicare health care 
options, benefits, rights and regulations. This research will evaluate 
how well CMS is currently meeting this mandate; Form Number: CMS-10080 
(OMB: 0938-0892); Frequency: Recordkeeping and Reporting: 
Quarterly; Affected Public: Individuals or households; Number of 
Respondents: 3880; Total Annual Responses: 3880; Total Annual Hours: 
1,356.
    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/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.
    Written comments and recommendations for the proposed information 
collections must be mailed or faxed within 30 days of this notice 
directly to the OMB desk officer:
    OMB Human Resources and Housing Branch, Attention: Carolyn Lovett, 
New Executive Office Building, Room 10235, Washington, DC 20503, Fax 
Number: (202) 395-6974.

    Dated: May 25, 2006.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
 [FR Doc. E6-8748 Filed 6-8-06; 8:45 am]
BILLING CODE 4120-01-P