[Federal Register Volume 84, Number 208 (Monday, October 28, 2019)]
[Notices]
[Pages 57734-57735]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-23504]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier CMS-3427 and CMS-484, 846, 854, 847, 848, 849, 
10125, and 10126]


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 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 must be received by December 27, 2019.

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.

[[Page 57735]]

    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 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 N. Parham at (410) 786-4669.

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-3427 End Stage Renal Disease Application and Survey and 
Certification Report
CMS-484, 846, 854, 847, 848, 849, 10125, and 10126 Durable Medical 
Equipment Medicare Administrative

    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: Reinstatement with 
change of a previously approved collection; Title of Information 
Collection: End Stage Renal Disease Application and Survey and 
Certification Report; Use: Part I of this form is a facility 
identification and screening measurement used to initiate the 
certification and recertification of ESRD facilities. Part II is 
completed by the Medicare/Medicaid State survey agency to determine 
facility compliance with ESRD conditions for coverage. Form Number: 
CMS-3427 (OMB control number: 0938-0360); Frequency: Every three years; 
Affected Public: Private sector (Business or other for-profit and Not-
for profit institutions); Number of Respondents: 7,493; Total Annual 
Responses: 2,473; Total Annual Hours: 824. (For policy questions 
regarding this collection contact Jennifer Milby at 410-786-8828).
    2. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
Durable Medical Equipment Medicare Administrative Contractor 
Certificate of Medical Necessity and Supporting Documentation 
Requirements; Use: The certificates of medical necessity (CMNs) collect 
information required to help determine the medical necessity of certain 
items. CMS requires CMNs where there may be a vulnerability to the 
Medicare program. Each initial claim for these items must have an 
associated CMN for the beneficiary. Suppliers (those who bill for the 
items) complete the administrative information (e.g., patient's name 
and address, items ordered, etc.) on each CMN. The 1994 Amendments to 
the Social Security Act require that the supplier also provide a 
narrative description of the items ordered and all related accessories, 
their charge for each of these items, and the Medicare fee schedule 
allowance (where applicable). The supplier then sends the CMN to the 
treating physician or other clinicians (e.g., physician assistant, LPN, 
etc.) who completes questions pertaining to the beneficiary's medical 
condition and signs the CMN. The physician or other clinician returns 
the CMN to the supplier who has the option to maintain a copy and then 
submits the CMN electronically to CMS, along with a claim for 
reimbursement. Form Numbers: CMS-484, 846, 847, 848, 849, 10125, 10126 
(OMB control number: 0938-0679); Frequency: Occasionally; Affected 
Public: Individuals or Households; Number of Respondents: 1,335,658; 
Total Annual Responses: 1,335,658; Total Annual Hours: 267,132. (For 
policy questions regarding this collection contact Melissa Singer at 
410-786-0365.)

    Dated: October 23, 2019.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2019-23504 Filed 10-25-19; 8:45 am]
 BILLING CODE 4120-01-P