[Federal Register Volume 72, Number 56 (Friday, March 23, 2007)]
[Notices]
[Pages 13792-13793]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E7-4901]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10220]


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: New collection; Title of 
Information Collection: Provider Enrollment Chain and Ownership System 
(PECOS) Web Security Consent Form; Form No.: CMS-10220 (OMB<greek-i> 
0938-NEW); Use: In establishing a Web based application process, we 
allow providers and suppliers the ability to enroll in the Medicare 
program via the Internet. For these applicants, no security consent 
form is needed to enroll or make a change in their Medicare enrollment 
information. These applicants receive complete access to their own 
enrollments through the Web based version of the Provider Enrollment, 
Chain and Ownership System (PECOS).
    In order to allow a provider or supplier to delegate the Medicare 
credentialing process to another individual or organization, it is 
necessary to establish a Security Consent Form for those providers and 
suppliers who choose to have another individual or organization access 
their enrollment information and complete enrollments on their behalf. 
These users could consist of administrative staff, independent 
contractors, or credentialing departments and are represented as a User 
group. User groups and its members must request access to enrollment 
data through a Security Consent Form. The security consent form 
replicates business service agreements between Medicare applicants and 
organizations providing enrollment services.
    We are proposing four different versions of the Security Consent 
Form. The form, once signed, mailed and approved, grants a user group 
or its member access to specific Medicare enrollment records. The 
system administrator, within the user group, assigns to each member of 
the group, a security role that will define their levels of 
functionality within PECOS web for an individual or organization. 
Frequency: Reporting--On occasion; Affected Public: Business or other 
for-profit, Not-for-profit institutions, Individuals or Households; 
Number of Respondents: 177,500; Total Annual Responses: 177,500; Total 
Annual Hours: 44,375.
    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 e-mail your request, including your address, phone number, OMB 
number, and CMS document identifier, to <a href="/cdn-cgi/l/email-protection#035362736671746c716843606e702d6b6b702d646c75"><span class="__cf_email__" data-cfemail="afffcedfcaddd8c0ddc4efccc2dc81c7c7dc81c8c0d9">[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 at the address below, 
no later than 5 p.m. on May 22, 2007.
    CMS, Office of Strategic Operations and Regulatory Affairs, 
Division of Regulations Development--B, Attention: William N. Parham, 
III, Room C4-26-05, 7500 Security Boulevard, Baltimore, Maryland 21244-
1850.


[[Page 13793]]


    Dated: March 8, 2007.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. E7-4901 Filed 3-22-07; 8:45 am]
BILLING CODE 4120-01-P


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