[Federal Register Volume 71, Number 18 (Friday, January 27, 2006)]
[Notices]
[Page 4583]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 06-749]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-855]


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 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; Form No.: CMS-855 (OMB <greek-i>0938-0685); 
Use: This application is currently required of all health care 
providers/suppliers who wish to enroll in the Medicare program. It is 
submitted when an applicant chooses to enroll into the Medicare program 
or when an enrolled provider or supplier reports a change to their 
Medicare information. The application is used by a Medicare fee-for-
service contractor to collect data to assure the applicant meets all 
Federal and State requirements to provide health care services to 
Medicare beneficiaries. This application also allows a Medicare fee-
for-service contractor to ensure that the provider/supplier is not 
sanctioned from the Medicare program, or debarred, suspended or 
excluded from any other Federal agency or program.; Frequency: 
Reporting--Other--; Affected Public: Business or other for-profit, 
Individuals or Households, Not-for-profit institutions; Number of 
Respondents: 400,000; Total Annual Responses: 400,000; Total Annual 
Hours: 1,200,000.
    To obtain copies of the supporting statement and any related forms 
for these paperwork collections referenced above, access CMS Web site 
address at http://www.cms.hhs.gov/PaperworkReductionActof1995, or e-
mail your request, including your address, phone number, OMB number, 
and CMS document identifier, to <a href="/cdn-cgi/l/email-protection#326253425740455d405972515f411c5a5a411c555d44"><span class="__cf_email__" data-cfemail="b3e3d2c3d6c1c4dcc1d8f3d0dec09ddbdbc09dd4dcc5">[email protected]</span></a>, or call the 
Reports Clearance Office on (410) 786-1326.
    To be assured consideration, comments and recommendations for the 
proposed information collections must be received by the OMB Desk 
Officer at the address below, no later than 5 p.m. on February 27, 
2006.
    OMB Human Resources and Housing Branch, Attention: Carolyn Lovett, 
CMS Desk Officer, New Executive Office Building, Room 10235, 
Washington, DC 20503.

    Dated: January 20, 2006.
Michelle Shortt,
Acting Director, Regulations Development Group, Office of Strategic 
Operations and Regulatory Affairs.
[FR Doc. 06-749 Filed 1-26-06; 8:45 am]
BILLING CODE 4120-01-M


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