Document Headings

                    Document headings vary by document type but may contain                    the following:                  
                -                       the agency or agencies that issued and signed a document                    
                -                       the number of the CFR title and the number of each part                      the document amends, proposes to amend, or is directly                      related to                    
                -                       the agency docket number / agency internal file number                    
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###### Department of Health and Human Services

###### Centers for Medicare and Medicaid Services 

          - [Document Identifier: CMS-10113] 

# AGENCY:

Centers for Medicare and Medicaid Services. 

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. 

*Type of Information Collection Request:*                         Revision of currently approved collection; Title of Information Collection: Application for Participation in Medicare Replacement Drug Demonstration;                         *Use:*                         Section 641 of the MMA mandated a demonstration that would pay for drugs/biologicals prescribed as replacements for existing covered Medicare drugs. A report to Congress evaluating the impact of this demonstration was also mandated. In order to enroll in this demonstration, a beneficiary will be required to submit the application forms. Beneficiaries who wish to be considered for a low-income subsidy must also provide the information on the “Application for Financial Assistance”;                         *Form Number:*                         CMS-10113 (OMB#: 0938-0924);                         *Frequency:*                         Other: Once per beneficiary;                         *Affected Public:*                         Individuals or Households;                         *Number of Respondents:*                         50,000; Total Annual Responses: 50,000;                         *Total Annual Hours:*                         20,417.                     

                        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://www.cms.hhs.gov/​      ( print page 62901)                                ,regulations/​pra/​,*                         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: Christopher Martin, New Executive Office Building, Room 10235, Washington, DC 20503.                     

Dated: October 21, 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.

[FR Doc. 04-24077 Filed 10-27-04; 8:45 am] 

BILLING CODE 4120-03-P