[Federal Register Volume 69, Number 223 (Friday, November 19, 2004)]
[Notices]
[Pages 67744-67745]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-25720]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: CMS-10052 and CMS-370, 377, 378, R-54]


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

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.
    1. Type of Information Collection Request: Extension of currently 
approved collection; Title of Information Collection: Recognition of 
Pass-Through Payment for Additional (new) Categories of Devices under 
the Outpatient Prospective Payment System and Supporting Regulations in 
42 CFR part 419; Use: Information is necessary to determine eligibility 
of medical devices for establishment of additional device categories 
for payment under

[[Page 67745]]

transitional pass-through payment provisions as required by section 
1833(t)(6) of the Social Security Act. Form Number: CMS-10052 
(OMB<greek-i>: 0938-0857); Frequency: On occasion; Affected Public: 
Business or other for-profit; Number of Respondents: 12; Total Annual 
Responses: 12; Total Annual Hours: 192.
    2. Type of Information Collection Request: Revision of currently 
approved collection; Title of Information Collection: Ambulatory 
Surgical Center (ASC) Health Insurance Benefit Agreement, ASC Request 
for Certification, ASC Survey Report and Supporting Regulations in 42 
CFR 416.41, 416.43, 416.47, and 416.48; Use: The ASC Health Insurance 
Benefits Agreement form is utilized for the purpose of establishing 
eligibility for payment under Title XVIII of the Social Security Act. 
The ASC Request for Certification form is utilized as an application 
for facilities wishing to participate in the Medicare program as an 
ASC. This form initiates the process of obtaining a decision as to 
whether the conditions of coverage are met. It also promotes data 
retrieval from the Online Data Input Edit (ODIE system, a subsystem of 
the Online Survey Certification and Report (OSCAR) system by the 
Centers for Medicare and Medicaid Services (CMS) Regional Offices 
(RO)). The ASC Report Form is an instrument used by the State survey 
agency to record data collection in order to determine supplier 
compliance with individual conditions of coverage and to report it to 
the Federal government. The form is primarily a coding worksheet 
designed to facilitate data reduction and retrieval into the ODIE/OSCAR 
system at the CMS ROs. This form includes basic information on 
compliance (i.e., met, not met and explanatory statements) and does not 
require any descriptive information regarding the survey activity 
itself; Form Number: CMS-370, 377, 378, R-54 (OMB<greek-i>: 0938-0266); 
Frequency: Annually and Other: once; Affected Public: State, Local or 
Tribal Government; Number of Respondents: 4,312; Total Annual 
Responses: 4,312; Total Annual Hours: 2,241.
    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/regulations/pra/, or E-mail your 
request, including your address, phone number, OMB number, and CMS 
document identifier, to <a href="/cdn-cgi/l/email-protection#c696a7b6a3b4b1a9b4ad86aea5a0a7e8a1a9b0"><span class="__cf_email__" data-cfemail="2b7b4a5b4e595c4459406b43484d4a054c445d">[email protected]</span></a>, 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: November 10, 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. 04-25720 Filed 11-18-04; 8:45 am]
BILLING CODE 4120-03-P


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