[Federal Register Volume 81, Number 78 (Friday, April 22, 2016)]
[Notices]
[Pages 23705-23706]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-09425]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-1490S and CMS-10458]


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 require; 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 minimize the information collection burden.

DATES: Comments must be received by June 21, 2016.

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-1490S Patient's Request for Medicare Payment

CMS-10458 Consumer Research Supporting Outreach for Health Insurance 
Marketplace

    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.
    1. Type of Information Collection Request: New collection (Request 
for a new OMB control number); Title of Information Collection: 
Patient's Request for Medicare Payment; Use: The Form CMS-1490S form 
provides beneficiaries with a relatively easy form to use when filing 
their claims. Without the collection of this information, claims for 
reimbursement relating to the provision of Part B medical services/
supplies could not be acted upon. This would result in a nationwide 
paralysis of the operation of the Federal Government's Part B Medicare 
program, and major problems for the patients/beneficiaries inflicting 
severe physical and financial hardship on beneficiaries. This form was 
explicitly developed for easy use by beneficiaries who file their own 
claims. The CMS-1490S form can be obtained from any Social Security 
office or Medicare Administrative Contractors or CMS. When the CMS-
1490S is used, the beneficiary must attach to it his/her bills from 
physicians or suppliers. The form is, therefore, designed specifically 
to aid beneficiaries who cannot get assistance from their physicians or 
suppliers for completing claim forms. The form is currently approved 
under 0938-1197; however, we are submitting for approval as a 
standalone information collection request. Once a new OMB control 
number is issued, we will remove the burden for the CMS-1490S that is 
currently approved under OMB control number 0938-1197. Form Number: 
CMS-1490 (OMB control number: 0938-NEW); Frequency: Occasionally 
Affected Public: Individuals and Households; Number of Respondents: 
167,839; Total Annual Responses: 167,839; Total Annual Hours: 83,920. 
(For policy questions regarding this collection contact Sumita Sen at 
410-786-5755.)

[[Page 23706]]

    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Consumer Research 
Supporting Outreach for Health Insurance Marketplace; Use: The Centers 
for Medicare and Medicaid Services is requesting reapproval for two 
surveys that aid in understanding levels of awareness and customer 
service needs associated with the Health Insurance Marketplace 
established by the Affordable Care Act. Because the Marketplace will 
provide coverage to the almost 50 million uninsured in the United 
States through individual and small employer programs, we have 
developed one survey to be administered to individual consumers most 
likely to use the Marketplace and another to be administered to small 
employers most likely to use the Small Business Health Options portion 
of the Marketplace. These brief surveys, designed to be conducted 
quarterly, give CMS the ability to obtain a rough indication of the 
types of outreach and marketing that will be needed to enhance 
awareness of and knowledge about the Marketplace for individual and 
business customers. CMS' biggest customer service need is likely to be 
providing sufficient education so consumers: (a) Can take advantage of 
the Marketplace and (b) know how to access CMS' customer service 
channels. The surveys will provide information on media use, concept 
awareness, and conceptual or content areas where education for customer 
service delivery can be improved. Awareness and knowledge gaps are 
likely to change over time based not only on effectiveness of CMS' 
marketing efforts, but also of those of state, local, private sector, 
and nongovernmental organizations. Form Number: CMS-10458 (OMB control 
number: 0938-1203): Frequency: Quarterly; Affected Public: Individuals 
or households, Private Sector (business or other for-profits); Number 
of Respondents: 40,200; Total Annual Responses: 40,200; Total Annual 
Hours: 2,480. (For policy questions regarding this collection contact 
Frank Funderburk at 410-786-1820.)

    Dated: April 19, 2016.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2016-09425 Filed 4-21-16; 8:45 am]
 BILLING CODE 4120-01-P