[Federal Register: November 7, 2003 (Volume 68, Number 216)]
[Notices]               
[Page 63106]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr07no03-80]                         

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-576, CMS-3427, CMS-R-282, CMS-372S]

 
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 Collection Request: Extension of a currently 
approved collection;
    Title of Information Collection: Organ Procurement Organization 
(OPO) Request for Designation and Supporting Regulations in 42 CFR 
486.304, 486.306, and 486.307; Form No.: CMS-576 (OMB 0938-
0512); Use: The information provided on this form serves as a basis for 
certifying OPOs for participation in the Medicare and Medicaid programs 
and will indicate whether the OPO is meeting the specified performance 
standards for reimbursement of service; Frequency: Annually; Affected 
Public: Business or other for-profit, and Not-for-profit institutions; 
Number of Respondents: 59; Total Annual Responses: 59; Total Annual 
Hours: 118.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: End Stage Renal 
Disease Application and Survey and Certification Report and Supporting 
Regulations in 42 CFR 488.60; Form No.: CMS-3427 (OMB 0938-
0360); 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; Frequency: Every three years; 
Affected Public: Business or other for-profit institutions, Not-for-
profit institutions; Number of Respondents: 4000; Total Annual 
Responses: 1,320; Total Annual Hours: 440.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare + Choice 
(M+C) Organization Appeals and Grievance Data Disclosure Requirements 
and Supporting Regulations in 42 CFR 422.64, 422.111, and 422.560-
422.626; Form No.: CMS-R-282 (OMB 0938-0778); Use: M+C 
organizations will collect information on appeals and grievance 
dispositions to help CMS monitor plan performance and to provide 
information to beneficiaries to help them make informed decisions about 
their or potential health plans' performance; Frequency: Semi-Annually; 
Affected Public: Business or other for-profit; Number of Respondents: 
211 TTotal Annual Responses: 422 Total Annual Hours: 422.
    4. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Annual Report on 
Home and Community Based Services Waivers and Supporting Regulations in 
42 CFR 440.180 and 441.300-.310; Form No.: CMS-372(S) (OMB 
0938-0272); Use: States request waivers in order for beneficiaries to 
have the option of receiving hospital services in their homes. States 
with an approved waiver under section 1915(c) of the Act are required 
to submit the CMS-372(S) annually in order for CMS to: (1) Verify that 
State assurances regarding waiver cost-neutrality are met, and (2) 
determine the waiver's impact on the type, amount and cost of services 
provided under the State plan and health and welfare of recipients; 
Frequency: Annually; Affected Public: State, local or tribal 
government; Number of Respondents: 50; TTotal Annual Responses: 277; 
Total Annual Hours: 20,775.
    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 Paperwork@hcfa.gov, or call the Reports 
Clearance Office on (410) 786-1326. 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: October 30, 2003.
Julie Brown,
CMS Reports Clearance Officer, Office of Strategic Operations and 
Strategic Affairs, Division of Regulations Development and Issuances.
[FR Doc. 03-28091 Filed 11-6-03; 8:45 am]

BILLING CODE 4120-03-P