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[Federal Register Volume 77, Number 19 (Monday, January 30, 2012)]
[Notices]
[Page 4564]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-1951]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier CMS-855I and CMS-855R]

Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services.

    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 for Physician and Non-Physician Practitioners. 
Use: Health care practitioners who wish to enroll in the Medicare 
program must complete the CMS 855I enrollment application. It is 
submitted at the time the applicant first requests a Medicare billing 
number. The application is used by the Medicare Administrative 
Contractor (MAC), to collect data to assure the applicant has the 
necessary professional and/or business credentials to provide the 
health care services for which they intend to bill Medicare including 
information that allows the MAC to correctly price, process and pay the 
applicant's claims. It also gathers information that allows the MAC to 
ensure that the practitioner is not sanctioned from the Medicare 
program, or debarred, suspended or excluded from any other Federal 
agency or program. Form Number: CMS-855I (OCN 0938-0685). Frequency: 
Once and Occasionally. Affected Public: Private Sector (Business or 
other for-profit and not-for-profit institutions). Number of 
Respondents: 345,000. Total Annual Responses: 345,000. Total Annual 
Hours: 824,000. (For policy questions regarding this collection contact 
Kimberly McPhillips at (410) 786-5374. For all other issues call (410) 
786-1326.)
    2. Type of Information Collection Request: New collection. Title of 
Information Collection: Medicare Enrollment Application--Reassignment 
of Medicare Benefits. Use: Health care practitioners who wish to 
reassign their benefits in the Medicare program must complete the CMS 
855R enrollment application. It is submitted at the time the physician 
or non-physician practitioner first requests reassignment of his/her 
Medicare benefits to a group practice, as well as any subsequent 
reassignments or terminations of established reassignments as requested 
by the physician or non-physician practitioner. The application is used 
by the Medicare Administrative Contractor (MAC) to collect data to 
assure the applicant has the necessary information that allows the MAC 
to correctly establish or terminate the reassignment. Form Number: CMS-
855R (OCN 0938-New). Frequency: Occasionally. Affected Public: Private 
Sector (Business or other for-profit and not-for-profit institutions). 
Number of Respondents: 100,000. Total Annual Responses: 100,000. Total 
Annual Hours: 50,000. (For policy questions regarding this collection 
contact Kimberly McPhillips at (410) 786-5374. 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 at (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 March 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 --------Room C4-26-05, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850.

    Dated: January 24, 2012.
Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2012-1951 Filed 1-27-12; 8:45 am]
BILLING CODE 4120-01-P
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