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[Federal Register Volume 77, Number 65 (Wednesday, April 4, 2012)]
[Notices]
[Pages 20403-20404]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-8009]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-855(S) and CMS-855(A,B,I,R); and CMS-10427]

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: Revision of a currently 
approved collection;
    Title of Information Collection: Medicare Enrollment Application--
Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) 
Suppliers Use: The primary function of the CMS 855S Durable Medical 
Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) supplier 
enrollment application is to gather information from a supplier that 
tells us who it is, whether it meets certain qualifications to be a 
health care supplier, where it renders its services or supplies, the 
identity of the owners of the enrolling entity, and information 
necessary to establish the correct claims payment. The goal of 
evaluating and revising the CMS 855S DMEPOS supplier enrollment 
application is to simplify and clarify the information collection 
without jeopardizing our need to collect specific information. The 
majority of the revisions contained in this submission are non-
substantive in nature such as spelling and formatting corrections; 
however, we also removed duplicate fields and obsolete questions and 
provided clarification and simplified the instructions for the 
completing the application. Form Number: CMS-855(S) (OCN: 0938-1056); 
Frequency: Yearly; Affected Public: Private Sector; Business or other 
for-profit and not-for-profit institutions; Number of Respondents: 
43,350; Total Annual Responses: 43,350; Total Annual Hours: 113,550 
(For policy questions regarding this contact Kim McPhillips at 410-786-
5374. For all other issues call 410-786-1326.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare 
Enrollment Application Use: The primary function of the CMS-855 
Medicare enrollment application is to gather information from a 
provider or supplier that tells us who it is, whether it meets certain 
qualifications to be a health care provider or supplier, where it 
practices or renders its services, the identity of the owners of the 
enrolling entity, and other information necessary to establish correct 
claims payments. Form Number: CMS-855(A, B, I, R) (OCN: 0938-0685); 
Frequency: Yearly; Affected Public: Private Sector; Business or other 
for-profit and not-for-profit institutions; Number of Respondents: 
440,450; Total Annual Responses: 440,450; Total Annual Hours: 856,395 
(For policy questions regarding this contact Kim McPhillips at 410-786-
5374. For all other issues call 410-786-1326.)
    3. Type of Information Collection Request: New collection; Title of 
Information Collection: For-Profit PACE Study; Use: The Program of All 
Inclusive Care of the Elderly (PACE) aims to provide integrated care 
and services to the frail elderly at risk of institutionalization to 
enable them to remain in the community. Under the Balanced Budget Act 
of 1997 (BBA), the not-for-profit PACE plans were established as 
permanent providers under the Medicare and Medicaid programs. The BBA 
also mandated a demonstration of for-profit PACE plans. This study will 
estimate the differences in quality and access to care between the for-
profit and not-for-profit PACE plans. The data collected in the survey 
will be used to measure the outcomes of interest-differences in access 
to and quality of care delivered to PACE enrollees. To measure these 
key outcomes, the survey will collect data on access to and 
satisfaction with healthcare, personal care, and transportation 
assistance provided by the plans. Form Number: CMS-10427 (OCN: 0938-
New); Frequency: Yearly; Affected Public: Individuals. Number of 
Respondents: 813. Number of Responses: 813. Total Annual Hours: 447. 
(For policy questions regarding this collection contact Julia Zucco at 
410-786-6670. 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

[[Page 20404]]

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 June 4, 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 ------, Room C4-26-05, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850.

    Dated: March 28, 2012.
Martique Jones,
Director, Regulations Development Group, Division B Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 2012-8009 Filed 4-3-12; 8:45 am]
BILLING CODE 4120-01-P
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