Federal Register / Vol. 77, No. 103 / Tuesday, May 29, 2012 / Notices 31615 

13 In particular, the written request for 

confidential treatment that accompanies the 

comment must include the factual and legal basis 

for the request, and must identify the specific 

portions of the comment to be withheld from the 

public record. See FTC Rule 4.9(c), 16 CFR 4.9(c). 

Web site, at http://www.ftc.gov/os/ 

publiccomments.shtm. As a matter of 

discretion, the Commission tries to 

remove individuals’ home contact 

information from comments before 

placing them on the Commission Web 

site. 

Because your comment will be made 

public, you are solely responsible for 

making sure that your comment does 

not include any sensitive personal 

information, like anyone’s Social 

Security number, date of birth, driver’s 

license number or other state 

identification number or foreign country 

equivalent, passport number, financial 

account number, or credit or debit card 

number. You are also solely responsible 

for making sure that your comment does 

not include any sensitive health 

information, like medical records or 

other individually identifiable health 

information. In addition, do not include 

any ‘‘[t]rade secret or any commercial or 

financial information which is obtained 

from any person and which is privileged 

or confidential’’ as provided in Section 

6(f) of the FTC Act, 15 U.S.C. 46(f), and 

FTC Rule 4.10(a)(2), 16 CFR 4.10(a)(2). 

In particular, do not include 

competitively sensitive information 

such as costs, sales statistics, 

inventories, formulas, patterns, devices, 

manufacturing processes, or customer 

names. 

If you want the Commission to give 

your comment confidential treatment, 

you must file it in paper form, with a 

request for confidential treatment, and 

you have to follow the procedure 

explained in FTC Rule 4.9(c).13 Your 

comment will be kept confidential only 

if the FTC General Counsel, in his or her 

sole discretion, grants your request in 

accordance with the law and the public 

interest. 

Postal mail addressed to the 

Commission is subject to delay due to 

heightened security screening. As a 

result, we encourage you to submit your 

comments online. To make sure that the 

Commission considers your online 

comment, you must file it at https:// 

ftcpublic.commentworks.com/ftc/ 

healthbreachnotificationPRA, by 

following the instructions on the webbased form. If this Notice appears at 

http://www.regulations.gov/#!home, you 

also may file a comment through that 

Web site. 

If you file your comment on paper, 

write ‘‘Health Breach Notification Rule, 

PRA comments, P–125402’’ on your 

comment and on the envelope, and mail 

or deliver it to the following address: 

Federal Trade Commission, Office of the 

Secretary, Room H–113 (Annex J), 600 

Pennsylvania Avenue NW., Washington, 

DC 20580. If possible, submit your 

paper comment to the Commission by 

courier or overnight service. 

Visit the Commission Web site at to 

read this Notice and the news release 

describing it. The FTC Act and other 

laws that the Commission administers 

permit the collection of public 

comments to consider and use in this 

proceeding as appropriate. The 

Commission will consider all timely 

and responsive public comments that it 

receives on or before July 30, 2012. You 

can find more information, including 

routine uses permitted by the Privacy 

Act, in the Commission’s privacy 

policy, at http://www.ftc.gov/ftc/ 

privacy.htm. 

Christian S. White, 

Acting General Counsel. 

[FR Doc. 2012–12863 Filed 5–25–12; 8:45 am] 

BILLING CODE 6750–01–P 

GENERAL SERVICES 

ADMINISTRATION 

[Notice–FMR–2012–G–03; Docket No. 2012– 

0004, Sequence 3] 

Improving Mail Management Policies, 

Procedures, and Activities 

AGENCY: Office of Governmentwide 

Policy, General Services Administration 

(GSA). 

ACTION: Notice of FMR Bulletin G–03. 

SUMMARY: The General Services 

Administration (GSA) has issued 

Federal Management Regulation (FMR) 

Bulletin G–03 which provides guidance 

to Executive Branch agencies for 

improving mail management policies, 

procedures, and activities. FMR Bulletin 

G–03 and all other FMR Bulletins may 

be found at http://www.gsa.gov/portal/ 

content/102955#MailManagement. 

DATES: Effective Date: This notice is 

effective May 29, 2012. 

Applicability Date: This notice 

applies to Mail Management Policy 

performed on or after May 2, 2012. 

FOR FURTHER INFORMATION CONTACT: Mr. 

Derrick Miliner, Office of 

Governmentwide Policy (MAF), Office 

of Asset and Transportation 

Management, General Services 

Administration at (202) 273–3564 or via 

email at derrick.miliner@gsa.gov. Please 

cite FMR Bulletin G–03. 

SUPPLEMENTARY INFORMATION: In an 

effort to cut waste, increase sustainable 

practices, remain in compliance with 

Executive Orders and the Federal 

Management Regulation, Federal 

agencies, internal policies should 

address the four requirements described 

in this bulletin. These include: (1) 

Consolidation of mail including 

presorting; (2) reductions of hard copy 

agency-to-agency mailings; (3) 

sustainable mail practices; and (4) 

secure mail for teleworkers. 

Dated: May 16, 2012. 

Carolyn Austin Diggs, 

Assistant Deputy Associate Administrator, 

Office of Asset and Transportation 

Management, Office of Governmentwide 

Policy. 

[FR Doc. 2012–12985 Filed 5–25–12; 8:45 am] 

BILLING CODE 6860–14–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–1500 (08/05) and 

CMS–1500 (2/12)] 

Agency Information Collection 

Activities: Proposed Collection; 

Comment Request 

AGENCY: Centers for Medicare & 

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 & Medicaid 

Services (CMS) 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: Reinstatement without change 

of a previously approved collection; 

Title of Information Collection: Health 

Insurance Common Claims Form and 

Supporting Regulations at 42 CFR part 

424, Subpart C; Use: The Form CMS– 

1500 answers the needs of many health 

insurers. It is the basic form prescribed 

by CMS for the Medicare program for 


srobinson on DSK4SPTVN1PROD with NOTICES
31616 Federal Register / Vol. 77, No. 103 / Tuesday, May 29, 2012 / Notices 

claims from physicians and suppliers. 

The Medicaid State Agencies, 

CHAMPUS/TriCare, Blue Cross/Blue 

Shield Plans, the Federal Employees 

Health Benefit Plan, and several private 

health plans also use it; it is the de facto 

standard ‘‘professional’’ claim form. 

Medicare carriers use the data 

collected on the CMS–1500 and the 

CMS–1490S to determine the proper 

amount of reimbursement for Part B 

medical and other health services (as 

listed in section 1861(s) of the Social 

Security Act) provided by physicians 

and suppliers to beneficiaries. The 

CMS–1500 is submitted by physicians/ 

suppliers for all Part B Medicare. 

Serving as a common claim form, the 

CMS–1500 can be used by other thirdparty payers (commercial and nonprofit 

health insurers) and other Federal 

programs (e.g., CHAMPUS/TriCare, 

Railroad Retirement Board (RRB), and 

Medicaid). 

However, as the CMS–1500 displays 

data items required for other third-party 

payers in addition to Medicare, the form 

is considered too complex for use by 

beneficiaries when they file their own 

claims. Therefore, the CMS–1490S 

(Patient’s Request for Medicare 

Payment) was explicitly developed for 

easy use by beneficiaries who file their 

own claims. The form can be obtained 

from any Social Security office or 

Medicare carrier. Form Number: CMS– 

1500(08/05), CMS–1490–S (OMB#: 

0938–0999); Frequency: Reporting—On 

occasion; Affected Public: State, Local, 

or Tribal Government, Business or 

other-for-profit, Not-for-profit 

institutions; Number of Respondents: 

1,448,346; Total Annual Responses: 

988,005,045; Total Annual Hours: 

21,418,336. (For policy questions 

regarding this collection contact Brian 

Reitz at 410–786–5001. For all other 

issues call 410–786–1326.) 

2. Type of Information Collection 

Request: New collection; Title of 

Information Collection: Health 

Insurance Common Claims Form and 

Supporting Regulations at 42 CFR part 

424, Subpart C; Use: The Form CMS– 

1500 answers the needs of many health 

insurers. It is the basic form prescribed 

by CMS for the Medicare program for 

claims from physicians and suppliers. 

The Medicaid State Agencies, 

CHAMPUS/TriCare, Blue Cross/Blue 

Shield Plans, the Federal Employees 

Health Benefit Plan, and several private 

health plans also use it; it is the de facto 

standard ‘‘professional’’ claim form. 

Medicare carriers use the data 

collected on the CMS–1500 and the 

CMS–1490S to determine the proper 

amount of reimbursement for Part B 

medical and other health services (as 

listed in section 1861(s) of the Social 

Security Act) provided by physicians 

and suppliers to beneficiaries. The 

CMS–1500 is submitted by physicians/ 

suppliers for all Part B Medicare. 

Serving as a common claim form, the 

CMS–1500 can be used by other thirdparty payers (commercial and nonprofit 

health insurers) and other Federal 

programs (e.g., CHAMPUS/TriCare, 

Railroad Retirement Board (RRB), and 

Medicaid). 

However, as the CMS–1500 displays 

data items required for other third-party 

payers in addition to Medicare, the form 

is considered too complex for use by 

beneficiaries when they file their own 

claims. Therefore, the CMS–1490S 

(Patient’s Request for Medicare 

Payment) was explicitly developed for 

easy use by beneficiaries who file their 

own claims. The form can be obtained 

from any Social Security office or 

Medicare carrier. 

Most recently, the National Uniform 

Claim Committee (NUCC) has revised 

the CMS–1500. The NUCC began 

revision work on the 1500 Claim Form, 

version 02/12 in 2009. The goal of this 

work was to align the paper form with 

some of the changes in the electronic 

Health Care Claim: Professional (837), 

005010X222 Technical Report Type 3 

(5010) and 005010X222A1 Technical 

Report Type 3 (5010A1). During the 

revision work, consideration was given 

to different approaches to revising the 

form. The NUCC decided to proceed 

with making ‘‘minor changes’’ to the 

current form, which was defined as no 

physical changes to the existing form 

lines or underlying layout of the form. 

Once the CMS–1500 (02/12) has been 

approved, the CMS–1500 (08/05) will be 

discontinued after a form runoff period 

during which both the CMS–1500 (08/ 

05) and the CMS–1500 (02/12) can be 

used. Form Number: CMS–1500(02/12), 

CMS–1490–S (OMB#: 0938–New); 

Frequency: Reporting—On occasion; 

Affected Public: State, Local, or Tribal 

Government, Business or other-forprofit, Not-for-profit institutions; 

Number of Respondents: 1,448,346; 

Total Annual Responses: 988,005,045; 

Total Annual Hours: 21,418,336. (For 

policy questions regarding this 

collection contact Brian Reitz at 410– 

786–5001. For all other issues call 410– 

786–1326.) 

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/ 

PaperworkReductionActof1995, or 

Email your request, including your 

address, phone number, OMB number, 

and CMS document identifier, to 

Paperwork@cms.hhs.gov, or call the 

Reports Clearance Office on (410) 786– 

1326. 

In commenting on the proposed 

information collections please reference 

the document identifier or OMB control 

number. To be assured consideration, 

comments and recommendations must 

be submitted in one of the following 

ways by July 30, 2012: 

1. Electronically. You may submit 

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) 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 llll, Room C4–26– 

05, 7500 Security Boulevard, Baltimore, 

Maryland 21244–1850. 

Dated: May 22, 2012. 

Martique Jones, 

Director, Regulations Development Group, 

Division B, Office of Strategic Operations and 

Regulatory Affairs. 

[FR Doc. 2012–12810 Filed 5–25–12; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[Document Identifier CMS–10426, CMS– 

10421 and CMS–10415] 

Agency Information Collection 

Activities: Submission for OMB 

Review; Comment Request 

AGENCY: Centers for Medicare & 

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 & Medicaid 

Services (CMS), 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 function; 

(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 


srobinson on DSK4SPTVN1PROD with NOTICES