[Federal Register Volume 85, Number 186 (Thursday, September 24, 2020)]
[Notices]
[Pages 60170-60172]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-21095]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-43, CMS-40B, CMS-R-285, and CMS-10175]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services, Health and Human 
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 November 23, 2020.

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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' website address at website address at https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html.
    2. 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-43 Application for Health Insurance Benefits Under Medicare for 
Individual with Chronic Renal Disease and Supporting Regulations in 42 
CFR
CMS-40B Application for Enrollment in Medicare the Medical Insurance 
Program
CMS-R-285 Request for Retirement Benefit Information
CMS-10175 Certification Statement for Electronic File Interchange 
Organizations that Submit NPI Data to the National Plan and Provider 
Enumeration System

    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 without change 
of a currently approved collection; Title of Information Collection: 
Application for Health Insurance Benefits Under Medicare for Individual 
with Chronic Renal Disease and Supporting Regulations in 42 CFR; Use: 
Individuals with End-Stage Renal Disease (ESRD) have the opportunity to 
apply for Medicare benefits and obtain premium-free Part A if they meet 
certain criteria outlined in statute. Sections 226A of the Act 
authorizes entitlement for Medicare Hospital Insurance (Part A) if the 
individual with ESRD files an application for benefits and meets the 
requisite contributions through one's own employment or the employment 
of a related individual to meet the statutory definition of a 
``currently insured'' individual outlined in section 214 of the Act. 
Further, for individuals who meet the requirements for premium-free 
Part A entitlement, Medicare coverage starts based on the dates in 
which the individual started dialysis treatment or had a kidney 
transplant. These statutory provisions are codified at 42 CFR 
406.7(c)(3) and 407.13.
    The CMS-43 form is used (in conjunction with the CMS-2728, OMB 
control number 0938-0046) to establish entitlement to Medicare Part A 
and enrollment in Medicare Part B for individuals with ESRD. Form CMS-
43 is only used for initial applications for Medicare by individuals 
diagnosed with ESRD. Form CMS-2728 provides the medical documentation 
that the individual has ESRD, and it accompanies Form CMS-43.
    Form CMS-43 is completed by the person applying for Medicare or by 
an SSA representative using information provided by the Medicare 
enrollee during an in-person interview. The majority of the forms are 
completed by an SSA representative on behalf of the individual applying 
for Medicare benefits. The form is owned by CMS, but not completed by 
CMS staff. Form Number: CMS-43 (OMB control number: 0938-0080); 
Frequency: Yearly; Affected Public: State, Local, or Tribal 
Governments; Number of Respondents: 20,382; Total Annual Responses: 
20,382; Total Annual Hours: 8,560. (For policy questions regarding this 
collection contact Carla Patterson at 410-786-1000.)
    2. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
Application for Enrollment in Medicare the Medical Insurance Program; 
Use: Section 1836 of the Act, and regulations at 42 CFR 407.10, provide 
the eligibility requirements for enrollment in Part B. Section 407.11 
lists the CMS-40B as the application to be used by individuals who wish 
to apply for Part B if they already have initial entitlement to 
premium-free Part A. Under the regulations, individuals may also enroll 
in Medicare Part B by signing a statement requesting Part B, if 
eligible for enrollment at that time. Individuals use the standardized 
Form CMS-40B to request enrollment.
    The CMS-40B provides the necessary information to determine 
eligibility and to process the beneficiary's request for enrollment for 
Medicare Part B coverage. This form is only used for enrollment by 
beneficiaries who already have Part A, but not Part B. Form CMS-40B is 
completed by the person with Medicare or occasionally by an SSA 
representative using information provided by the Medicare enrollee 
during an in-person interview. The form is owned by CMS, but not 
completed by CMS staff. SSA processes Medicare enrollments on behalf of 
CMS. Form Number: CMS-40B (OMB control number: 0938-1230); Frequency: 
Yearly; Affected Public: State, Local, or Tribal Governments; Number of 
Respondents: 400,000; Total Annual Responses: 400,000; Total Annual 
Hours: 100,000. (For policy questions regarding this collection contact 
Carla Patterson at 410-786-1000.)
    3. Type of Information Collection Request: Extension without change 
of a currently approved collection; Title of Information Collection: 
Request for Retirement Benefit Information; Use: Section 1818(d)(5) of 
the Social Security Act (the Act) provides that certain former State 
and local government employees (and their current or former spouses) 
may have the Part A premium reduced to zero.
    Form CMS-R-285, ``Request for Retirement Benefit Information,'' is 
used to obtain information regarding whether

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a beneficiary currently purchasing Medicare premium Part A coverage, is 
receiving retirement payments based on State or local government 
employment, how long the claimant worked for the State or local 
government employer, and whether the former employer or pension plan is 
subsidizing the individual's Part A premium.
    Form CMS-R-285 provides the necessary information regarding the 
prior state or local government employment to process the individual's 
request for premium Part A reduction based on their employment by a 
state or local government.
    The form is completed by the state or local government employer on 
behalf of the individual seeking the Medicare premium reduction. The 
SSA--CMS' agent for processing Medicare enrollments and premium amount 
determinations will use this information to help determine whether a 
beneficiary meets the requirements for reduction of the Part A premium. 
The form is owned by CMS but not completed by CMS staff. Form Number: 
CMS-R-285 (OMB control number: 0938-0769); Frequency: Yearly; Affected 
Public: State, Local, or Tribal Governments; Number of Respondents: 
500; Total Annual Responses: 500; Total Annual Hours: 125. (For policy 
questions regarding this collection contact Carla Patterson at 410-786-
1000.)
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Certification 
Statement for Electronic File Interchange Organizations (EFIOs) that 
submit National Provider Identifier (NPI) data to the National Plan and 
Provider Enumeration System (NPPES); Use: The EFI process allows 
organizations to submit NPI application information on large numbers of 
providers in a single file. Once it has obtained and formatted the 
necessary provider data, the EFIO can electronically submit the file to 
NPPES for processing. As each file can contain up to approximately 
25,000 records, or provider applications, the EFI process greatly 
reduces the paperwork and overall administrative burden associated with 
enumerating providers. It is essential to collect this information from 
the EFIO to ensure that the EFIO understands its legal responsibilities 
as an EFIO and attests that it has the authority to act on behalf of 
the providers for whom it is submitting data. In short, the 
certification statement, which must be signed by an authorized official 
of the EFIO, serves as a safeguard against EFIOs attempting to obtain 
NPIs for illicit or inappropriate purposes. Form Number: CMS-10175 (OMB 
control number 0938-0984); Frequency: Once, Annually; Affected Public: 
Private Sector, State, Business, and Not-for Profits; Number of 
Respondents: 32; Number of Responses: 32; Total Annual Hours: 8. For 
questions regarding this collection contact DaVona Boyd at 410-786-
7483.

    Dated: September 21, 2020.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and 
Regulatory Affairs.
[FR Doc. 2020-21095 Filed 9-23-20; 8:45 am]
BILLING CODE 4120-01-P