[Federal Register Volume 90, Number 148 (Tuesday, August 5, 2025)]
[Notices]
[Pages 37514-37515]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2025-14829]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-1763 and CMS-1696]
Agency Information Collection Activities: Submission for OMB
Review; 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 (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 September 4, 2025.
ADDRESSES: Written comments and recommendations for the proposed
information collection should be sent within 30 days of publication of
this notice to www.reginfo.gov/public/do/PRAMain. Find this particular
information collection by selecting ``Currently under 30-day Review--
Open for Public Comments'' or by using the search function.
To obtain copies of a supporting statement and any related forms
for the proposed collection(s) summarized in this notice, please access
the CMS PRA website by copying and pasting the following web address
into your web browser: https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.
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. 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: Revision of a currently
approved collection; Title of Information Collection: Request for
Termination of Medicare Premium Part A, Part B, or Part B
Immunosuppressive Drug Coverage (Part B-ID) and Supporting Statute and
Regulations; Use: Sections 1818(c)(5), 1818A(c)(2)(B) and 1838(b)(1) of
the Act and corresponding regulations at 42 CFR 406.28(a) and 407.27(c)
require that a Medicare enrollee wishing to voluntarily terminate Part
B or premium Part A coverage file a written request with CMS or SSA.
Pursuant to 1838(h) of the Act and the corresponding regulation at 42
CFR 407.62(a), individuals wishing to terminate their Part B-ID
coverage must notify SSA. The statute and regulations also specify when
coverage ends based upon the date the request for termination is filed.
The CMS-1763 is the form used by individuals who wish to terminate
their Medicare Part A, Part B or Part B-ID. This 2024 iteration is a
revision that does not propose any program changes.
[[Page 37515]]
Per the Office of Communication's plain language suggestion, the title
has been updated to ``Request for Termination of Medicare Premium Part
A, Part B, or Part B Immunosuppressive Drug Coverage (Part B-ID).'' The
2024 submission saw an increase in the burden due to utilization of the
form and improvement in the accuracy of the data exchanges between CMS
and SSA. Updated wage information for a federal government employee is
also responsible for part of the increase. Form Number: CMS-1763 (OMB
control number 0938-0025); Frequency: Biennially; Affected Public:
Private Sector--State, Local, or Tribal Governments; and Federal
Government; Number of Respondents: 197,518; Total Annual Responses:
197,518; Total Annual Hours: 33,578. (For policy questions regarding
this collection contact Tyrissa Woods at 410-786-0286 or
[email protected].)
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Appointment of
Representative; Use: The requirements for appointing representatives
for claims and appeals processed under 42 CFR part 405 Subpart I were
codified into regulation at 42 CFR 405.910. In summary, section 405.910
states an individual or entity may appoint a representative to act on
their behalf in exercising their rights relative to an initial claim
determination or an appeal. The appointment of representation must be
in writing and must include all the required elements specified in
405.910(c). The burden associated with this requirement is the time and
effort of the individual or entity to prepare an appointment of
representation containing all the required information of this section.
This form would be completed by Medicare beneficiaries, providers,
and suppliers (typically their billing clerk, or billing company), and
any party who wish to appoint a representative to assist them with
their initial Medicare claims determinations and filing appeals on
Medicare claims. The information supplied on the form is reviewed by
Medicare claims and appeals adjudicators. The adjudicators make
determinations whether the form was completed accurately, and if the
form is correct and accepted, the form is appended to the claim or
appeal that it was filed with Form Number: CMS-1696 (OMB control
number: 0938-0950); Frequency: Occasionally; Affected Public:
Individuals and Households and Private Sector; Number of Respondents:
208,173; Total Annual Responses: 208,173; Total Annual Hours: 52,043.
(For policy questions regarding this collection contact Katherine Hosna
at (410) 786-4993 or [email protected].)
William N. Parham, III,
Director, Division of Information Collections and Regulatory Impacts,
Office of Strategic Operations and Regulatory Affairs.
[FR Doc. 2025-14829 Filed 8-4-25; 8:45 am]
BILLING CODE 4120-01-P