[Federal Register Volume 79, Number 1 (Thursday, January 2, 2014)]
[Notices]
[Pages 140-141]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-31390]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-40B, CMS-2088-92, and CMS-R-297 (CMS-L564)]


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

ACTION: Notice.

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SUMMARY: The Centers for Medicare & Medicaid Services (CMS) is 
announcing an opportunity for the public to comment on CMS' intention 
to collect information from the public. Under the Paperwork Reduction 
Act of 1995 (PRA), federal agencies are required to publish notice in 
the Federal Register concerning each proposed collection of 
information, including each proposed extension or reinstatement of an 
existing collection of information, and to allow a second opportunity 
for public comment on the notice. Interested persons are invited to 
send comments regarding the 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.

DATES: Comments on the collection(s) of information must be received by 
the OMB desk officer by February 3, 2014.

ADDRESSES: When commenting on the proposed information collections, 
please reference the document identifier or OMB control number. To be 
assured consideration, comments and recommendations must be received by 
the OMB desk officer via one of the following transmissions: OMB, 
Office of Information and Regulatory Affairs, Attention: CMS Desk 
Officer, Fax Number: (202) 395-5806 OR Email: [email protected].
    To obtain copies of a supporting statement and any related forms 
for the proposed collection(s) summarized in this notice, you may make 
your request using one of following:
    1. Access CMS' Web site address at http://www.cms.hhs.gov/PaperworkReductionActof1995.
    2. Email your request, including your address, phone number, OMB 
number, and CMS document identifier, to [email protected].
    3. Call the Reports Clearance Office at (410) 786-1326.

FOR FURTHER INFORMATION CONTACT: Reports Clearance Office at (410) 786-
1326.

SUPPLEMENTARY INFORMATION: Under the Paperwork Reduction Act of 1995 
(PRA) (44 U.S.C. 3501-3520), federal agencies must obtain approval from 
the Office of Management and Budget (OMB) for each collection of 
information they conduct or sponsor. The term ``collection of 
information'' is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and 
includes agency requests or requirements that members of the public 
submit reports, keep records, or provide information to a third party. 
Section 3506(c)(2)(A) of the PRA (44 U.S.C. 3506(c)(2)(A)) requires 
federal agencies to publish a 30-day notice in the Federal Register 
concerning each proposed collection of information, including each 
proposed extension or reinstatement of an existing collection of 
information, before submitting the collection to OMB for approval. To 
comply with this requirement, CMS is publishing this notice that 
summarizes the following proposed collection(s) of information for 
public comment:
    1. Type of Information Collection Request: New collection (Request 
for a new OMB control number); Title of Information Collection: 
Application for Enrollment in Medicare the Medical Insurance Program; 
Use: Form CMS-40B is used to establish entitlement to and enrollment in 
supplementary medical insurance for beneficiaries who already have Part 
A, but not Part B. The form solicits information that is used to 
determine enrollment for individuals who meet the requirements in 
section 1836 of the Social Security Act as well as the entitlement of 
the applicant or a spouse regarding a benefit or annuity paid by the 
Social Security Administration or the Office of Personnel Management 
for premium deduction purposes. The Social Security Administration will 
use the collected information to establish Part B enrollment. Form 
Number: CMS-40B (OCN: 0938-New); Frequency: Once; Affected Public: 
Individuals or households; Number of Respondents: 200,000; Total Annual 
Responses: 200,000; Total Annual Hours: 50,000. (For policy questions 
regarding this collection contact Lindsay Smith at 410-786-6843.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Outpatient 
Rehabilitation Facility, Community Mental Health Center Cost Report and 
Supporting Regulations; Use: The cost reports are required to be filed 
with the provider's Medicare Administrative Contractor (MAC). The MAC 
uses the cost reports to calculate the provider's cost to charge ratios 
which are used to compute outlier payments and to determine a 
provider's final cost settlement by comparing the provider's interim 
payments received to the reasonable cost for the fiscal period covered 
by the cost report.
    The collection of data is a secondary function of the cost report. 
We use the data to support program operations, payment refinement 
activities, and to make Medicare Trust Fund projections. We along with 
other stakeholders use the data to analyze a myriad of health care 
measures on a national level. Stakeholders include the Office of 
Management and Budget, the Congressional Budget Office, the Medicare 
Payment Advisory Commission, Congress, researchers, universities, and 
other interested parties. Form Number: CMS-2088-92 (OCN: 0938-0037); 
Frequency: Yearly; Affected Public: Private sector--Business or other 
for-profits and Not-for-profit institutions; Number of Respondents: 
540; Total Annual Responses: 540; Total Annual Hours: 54,000. (For 
policy questions regarding this collection contact Jill Keplinger at 
410-786-4550.)
    3. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Request for 
Employment Information; Use: Section 1837(i) of the Social Security Act 
provides for a special enrollment period for individuals who delay 
enrolling in Medicare Part B because they are covered by a group health 
plan based on their own or a spouse's current employment status. 
Disabled individuals with Medicare may also delay enrollment because 
they have large group health plan coverage based on their own or a 
family member's current employment status. When these individuals apply 
for Medicare Part B, they must provide proof that the group health plan 
coverage is (or was) based on current employment status. Form

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Number: CMS-R-297 (CMS-L564) (OCN: 0938-0787); Frequency: Once; 
Affected Public: Private sector--Business or other for-profits and Not-
for-profit institutions; Number of Respondents: 15,000; Total Annual 
Responses: 15,000; Total Annual Hours: 5,000. (For policy questions 
regarding this collection contact Lindsay Smith at 410-786-6843.)

    Dated: December 27, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2013-31390 Filed 12-31-13; 8:45 am]
BILLING CODE 4120-01-P