[Federal Register Volume 84, Number 111 (Monday, June 10, 2019)]
[Notices]
[Pages 26877-26878]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-12118]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier CMS-855R]


Agency Information Collection Activities: Submission for OMB 
Review; 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 (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 the necessity and utility of the 
proposed information collection for the proper performance of the 
agency's functions, the accuracy of the estimated burden, ways to 
enhance the quality, utility, and clarity of the information to be 
collected, and 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 July 10, 2019.

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' website address at https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html.
    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: William Parham at (410) 786-4669.

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.

[[Page 26878]]

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: Extension of a currently 
approved information collection request; Title of Information 
Collection: Reassignment of Medicare Benefits; Use: The reassignment 
application is submitted at the time the provider/supplier first 
reassigns of his/her Medicare benefits to a group practice, as well as 
any subsequent reassignments, changes to current reassignment 
information or terminations of established reassignments as requested 
by the provider/supplier or group. The application is used by the 
Medicare Administrative Contractor (MAC) to collect data to assure the 
applicant has the necessary information that allows the MAC to 
correctly establish, change, or terminate the reassignment.
    The collection and verification of reassignment information defends 
and protects our beneficiaries from illegitimate providers/suppliers. 
These procedures also protect the Medicare Trust Fund against fraud. It 
gathers information that allow Medicare contractors to ensure that the 
provider/supplier is not sanctioned from the Medicare and/or Medicaid 
program(s), or debarred, or excluded from any other Federal agency or 
program. The data (e.g., Social Security Numbers, Employer 
Identification Numbers) collected also ensures that the applicant has 
the necessary credentials to provide the health care services for which 
they intend to bill Medicare through the reassignment. This is sole 
instrument implemented for this purpose. Form Number: CMS-855R (OMB 
control number: 0938-1179); Frequency: Occasionally; Affected Public: 
Private Sector; Businesses or other for-profits, Not-for-profit 
institutions; Number of Respondents: 357,628; Number of Responses: 
357,628; Total Annual Hours: 89,407. For policy questions regarding 
this collection, contact Kimberly McPhillips at 410-786-5374.

    Dated: June 5, 2019.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2019-12118 Filed 6-7-19; 8:45 am]
BILLING CODE 4120-01-P