04-8531. Agency Information Collection Activities: Submission for OMB Review; Comment Request

AGENCY:

Centers for Medicare and Medicaid Services, HHS.

In compliance with the requirement of section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Centers for Medicare and Medicaid Services (CMS) (formerly known as the Health Care Financing Administration (HCFA), Department of Health and Human Services, is publishing the following summary of proposed collections for public comment. Interested persons are invited to send comments regarding this burden estimate 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.

1. Type of Information Request: Extension of a currently approved collection.

Title of Information Collection: Medicare Secondary Payer Information Collection and Supporting Regulations in 42 CFR 411.25, 489.2, and 489.20.

Form Number: CMS-250 through CMS-254 (OMB# 0938-0214).

Use: Medicare Secondary Payer (MSP) is essentially the same concept known in the private insurance industry as coordination of benefits and refers to those situations where Medicare does not have primary responsibility for paying the medical expenses of a Medicare beneficiary. Medicare intermediaries and carriers must collect information to perform various tasks to detect and process MSP cases.

Frequency: On occasion and Other: One time.

Affected Public: Individuals or households, Business or other for-profit, and not-for-profit institutions.

Number of Respondents: 134,553,682.

Total Annual Responses: 134,553,682;

Total Annual Hours Requested: 1,114,839.

2. Type of Information Collection Request: Revision of a currently approved collection.

Title of Information Collection: Request for Review of Part B Medicare Claim and Supporting Regulations in 42 CFR 405.807.

Form No.: CMS-1964 (OMB# 0938-0033).

Use: This form is the preferred manner to enable appellants to request a Part B review by a carrier.

Frequency: Other: as needed.

Affected Public: Individuals or Households, and not-for-profit institutions.

Number of Respondents: 6,860,000.

Total Annual Responses: 6,860,000.

Total Annual Hours: 1,715,000.

To obtain copies of the supporting statement and any related forms for the proposed paperwork collections referenced above, access CMS Web site address at http://cms.hhs.gov/​regulations/​pra/​default.asp, or e-mail your request, including your address, phone number, OMB number, and CMS document identifier, to [e-mail], or call the Reports Clearance Office on [phone]. Written comments and recommendations for the proposed information collections must be mailed within 30 days of this notice directly to the OMB desk officer: OMB Human Resources and Housing Branch, Attention: Brenda Aguilar, New Executive Office Building, Room 10235, Washington, DC 20503.

Dated: April 8, 2004.

John P. Burke, III,

Paperwork Reduction Act Team Leader, CMS Reports Clearance Officer, Office of Strategic Operations and Regulatory Affairs, Division of Regulations Development and Issuances.