[Federal Register Volume 80, Number 39 (Friday, February 27, 2015)]
[Notices]
[Pages 10686-10687]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-04115]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-1696 and CMS-10417]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services, HHS.

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 (the 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 60 days for public 
comment on the proposed action. Interested persons are invited to send 
comments regarding our burden estimates 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

[[Page 10687]]

minimize the information collection burden.

DATES: Comments must be received by April 28, 2015.

ADDRESSES: When commenting, please reference the document identifier or 
OMB control number. To be assured consideration, comments and 
recommendations must be submitted in any one of the following ways:
    1. Electronically. You may send your comments electronically to 
http://www.regulations.gov. Follow the instructions for ``Comment or 
Submission'' or ``More Search Options'' to find the information 
collection document(s) that are accepting comments.
    2. By regular mail. You may mail written comments to the following 
address: CMS, Office of Strategic Operations and Regulatory Affairs, 
Division of Regulations Development, Attention: Document Identifier/OMB 
Control Number ____, Room C4-26-05, 7500 Security Boulevard, Baltimore, 
Maryland 21244-1850.
    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:

Contents

    This notice sets out a summary of the use and burden associated 
with the following information collections. More detailed information 
can be found in each collection's supporting statement and associated 
materials (see ADDRESSES).

CMS-1696 Appointment of Representative

    Under the 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 requires federal agencies 
to publish a 60-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.

Information Collection

    1. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Appointment of 
Representative; Use: The Appointment of Representative form is 
completed by beneficiaries, providers and suppliers, and any party 
seeking to appoint a representative to assist them with their initial 
determinations and filing appeals. This extension request proposes non-
substantive changes to the form. Form Number: CMS-1696 (OMB control 
number 0938-0950); Frequency: Once; Affected Public: Individuals and 
households and the Private sector (Business or other for-profits); 
Number of Respondents: 4,073,960; Total Annual Responses: 407,396; 
Total Annual Hours: 101,849. (For policy questions regarding this 
collection contact Katherine Hosna at 410-786-4993).
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare Fee-for-
Service Prepayment Medical Review; Use: The information required under 
this collection is requested by Medicare contractors to determine 
proper payment or if there is a suspicion of fraud. Medicare 
contractors request the information from providers or suppliers 
submitting claims for payment from the Medicare program when data 
analysis indicates aberrant billing patterns or other information which 
may present a vulnerability to the Medicare program. Form Number: CMS-
10417 (OMB control number: 0938-0969); Frequency: Occasionally; 
Affected Public: Private Sector (Business or other for-profit and Not-
for-profit institutions); Number of Respondents: 3,211,800; Total 
Annual Responses: 3,211,800; Total Annual Hours: 1,597,950. (For policy 
questions regarding this collection contact Debbie Skinner at 410-786-
7480.)

    Dated: February 24, 2015.
William N. Parham, III
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2015-04115 Filed 2-26-15; 8:45 am]
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