[Federal Register Volume 78, Number 235 (Friday, December 6, 2013)]
[Notices]
[Pages 73545-73546]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-29144]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifiers: CMS-18F5, CMS-10120, and CMS-10346]
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 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.
DATES: Comments must be received by February 4, 2014.
ADDRESSES: When commenting, please reference the document identifier or
OMB control number (OCN). 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' Web site address at http://www.cms.hhs.gov/PaperworkReductionActof1995.
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: Reports Clearance Office at (410) 786-
1326.
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-18F5 Application for Hospital Insurance and Supporting Regulations
CMS-10120 1932(a) State Plan Amendment Template, State Plan
Requirements, and Supporting Regulations
[[Page 73546]]
CMS-10346 Appeals of Quality Bonus Payment Determinations
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 Collections
1. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Application for
Hospital Insurance and Supporting Regulations; Use: Regulations at 42
CFR 406.6 specifies the individuals who must file an application for
Medicare Hospital Insurance (Part A) and those who need not file an
application for Part A. Section 406.7 lists CMS-18F5 as the application
form. The form elicits information that the Social Security
Administration and CMS need to determine entitlement to Part A and
Supplementary Medical Insurance (Part B); Form Number: CMS-18F5 (OCN:
0938-0251); Frequency: Once; Affected Public: Individuals or
households; Number of Respondents: 50,000; Total Annual Responses:
50,000; Total Annual Hours: 12,500. (For policy questions regarding
this collection contact Naomi Rappaport at 410-786-2175).
2. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: 1932(a) State
Plan Amendment Template, State Plan Requirements, and Supporting
Regulations; Use: Section 1932(a)(1)(A) of the Social Security Act (the
Act) grants states the authority to enroll Medicaid beneficiaries on a
mandatory basis into managed care entities (managed care organization
(MCOs) and primary care case managers (PCCMs)). Under this authority, a
state can amend its Medicaid state plan to require certain categories
of Medicaid beneficiaries to enroll in managed care entities without
being out of compliance with provisions of section 1902 of the Act on
statewideness (42 CFR 431.50), freedom of choice (42 CFR 431.51) or
comparability (42 CFR 440.230). The template may be used by states to
easily modify their state plans if they choose to implement the
provisions of section 1932(a)(1)(A); Form Number: CMS-10120 (OCN: 0938-
0933); Frequency: Once and occasionally; Affected Public: State, Local,
or Tribal Governments; Number of Respondents: 56; Total Annual
Responses: 15; Total Annual Hours: 65. (For policy questions regarding
this collection contact Camille Dobson at 410-786-7062).
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Appeals of
Quality Bonus Payment Determinations; Use: The information collected
from Medicare Advantage organizations is considered by the
reconsideration official and potentially the hearing officer to review
our determination of the organization's eligibility for a quality bonus
payment. Form Number: CMS-10346 (OCN: 0938-1129; Frequency: Yearly;
Affected Public: Private sector--Business or other for-profits; Number
of Respondents: 350; Total Annual Responses: 25; Total Annual Hours:
200. (For policy questions regarding this collection contact Sarah
Gaillot at 410-786-4637).
Dated: December 3, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic
Operations and Regulatory Affairs.
[FR Doc. 2013-29144 Filed 12-5-13; 8:45 am]
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