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DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Medicare & Medicaid Services 

[Document Identifier: CMS-10054] 

Agency Information Collection Activities: Proposed Collection; Comment Request 

AGENCY: Centers for Medicare & Medicaid Services. 

ACTION: Notice. 

SUMMARY: The Centers for Medicare & Medicaid Services (CMS) is announcing an 

opportunity for the public to comment on CMS’ intention to collect information from the public. 

Under the Paperwork Reduction Act of 1995 (the PRA), federal agencies are required to publish 

notice in the Federal Register concerning each proposed collection of information (including 

each proposed extension or reinstatement of an existing collection of information) and to allow 

60 days for public comment on the proposed action. Interested persons are invited to send 

comments regarding our burden estimates or any other aspect of this collection of information, 

including any of the following subjects: the necessity and utility of the proposed information 

collection for the proper performance of the agency’s functions; the accuracy of the estimated 

burden; ways to enhance the quality, utility, and clarity of the information to be collected; and 

the use of automated collection techniques or other forms of information technology to minimize 

the information collection burden. 

DATES: Comments must be received by [INSERT DATE 60 DAYS AFTER THE DATE OF 

FILING FOR PUBLIC INSPECTION AT THE OFR]. 

ADDRESSES: When commenting, please reference the document identifier or OMB control 

number (OCN). To be assured consideration, comments and recommendations must be 

submitted in any one of the following ways: 
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 1. Electronically. You may send 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) that are 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. 

To obtain copies of a supporting statement and any related forms for the proposed 

collection(s) summarized in this notice, you may make your request using one of following: 

1. Access CMS’ Web Site address at 

http://www.cms.hhs.gov/PaperworkReductionActof1995. 

2. E-mail your request, including your address, phone number, OMB number, and CMS 

document identifier, to Paperwork@cms.hhs.gov.

3. Call the Reports Clearance Office at (410) 786-1326. 

FOR FURTHER INFORMATION CONTACT: 

Reports Clearance Office at (410) 786-1326 

SUPPLEMENTARY INFORMATION: 

Contents 
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 This notice sets out a summary of the use and burden associated with the following 

information collection. More detailed information can be found in the collection’s supporting 

statement and associated materials (see ADDRESSES). 

CMS-10054 Recognition of Payment for New Technology Services for New Technology 

Ambulatory Payment Classification (APC) Groups Under the Outpatient Prospective Payment 

System and Supporting Regulations in 42 CFR part 419 

Under the Paperwork ReductionAct (PRA) (44 U.S.C. 3501-3520), federal agencies must 

obtain approval from the Office of Management and Budget (OMB) for each collection of 

information they conduct or sponsor. The term "collection of information" is defined in 44 

U.S.C. 3502(3) and 5 CFR 1320.3(c) and includes agency requests or requirements that members 

of the public submit reports, keep records, or provide information to a third party. Section 

3506(c)(2)(A) of the PRA requires federal agencies to publish a 60-day notice in the Federal 

Register concerning each proposed collection of information, including each proposed extension 

or reinstatement of an existing collection of information, before submitting the collection to 

OMB for approval. To comply with this requirement, CMS is publishing this notice. 

Information Collection 

1. Type of Information Collection Request: Extension of a currently approved 

collection; Title of Information Collection: Recognition of Payment for New Technology 

Services for New Technology Ambulatory Payment Classification (APC) Groups Under the 

Outpatient Prospective Payment System and Supporting Regulations in 42 CFR part 419; Use: 

CMS needs to keep pace with emerging new technologies and make them accessible to Medicare 

beneficiaries in a timely manner. It is necessary that we continue to collect appropriate 

information from interested parties such as hospitals, medical device manufacturers, 
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pharmaceutical companies and others that bring to our attention specific services that they wish 

us to evaluate for New Technology APC payment. Form Number: CMS-10054 (OCN: 0938-

0860); Frequency: Once; Affected Public: Private sector (business or other for-profits); Number 

of Respondents: 10; Total Annual Responses: 10; Total Annual Hours: 160. (For policy 

questions regarding this collection contact Barry Levi at 410-786-4529). 
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Dated: February 26, 2014. 

Martique Jones 

Deputy Director, Regulations Development Group 

Office of Strategic Operations and Regulatory Affairs 

Billing Code: 4120-01-U-P 

[FR Doc. 2014-04613 Filed 02/28/2014 at 8:45 am; Publication Date: 03/03/2014]