[Federal Register Volume 89, Number 210 (Wednesday, October 30, 2024)]
[Notices]
[Pages 86340-86342]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-25148]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifiers: CMS-10341, CMS-10875, CMS-40B, CMS-10797 and 
CMS-4040]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services, Health and Human 
Services (HHS).

ACTION: Notice.

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

[[Page 86341]]

an opportunity for the public to comment on CMS' intention to collect 
information from the public. Under the Paperwork Reduction Act of 1995 
(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 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 December 30, 2024.

ADDRESSES: When commenting, please reference the document identifier or 
OMB control number. To be assured consideration, comments and 
recommendations must be submitted in any one of the following ways:
    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, please access 
the CMS PRA website by copying and pasting the following web address 
into your web browser: https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.

FOR FURTHER INFORMATION CONTACT: William N. Parham at (410) 786-4669.

SUPPLEMENTARY INFORMATION: 

Contents

    This notice sets out a summary of the use and burden associated 
with the following information collections. More detailed information 
can be found in each collection's supporting statement and associated 
materials (see ADDRESSES).

CMS-10341 Section 1115 Demonstration Projects Regulations
CMS-10875 Reporting Requirements and Corrective Action Plans Under 
Section 1902(tt) of the Social Security Act
CMS-40B Application for Enrollment in Medicare Part B (Medical 
Insurance)
CMS-10797 Application for Medicare Part A and Part B Special Enrollment 
Period
(Exceptional Circumstances)
CMS-4040 Request for Enrollment in Supplementary Medical Insurance 
(SMI)

    Under the 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 Collections

    1. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Section 1115 
Demonstration Projects Regulations at 42 CFR 431.408, 431.412, 431.420, 
431.424, and 431.428; Use: This collection is necessary to ensure that 
states comply with regulatory and statutory requirements related to the 
development, implementation and evaluation of demonstration projects. 
States seeking waiver authority under section 1115 are required to meet 
certain requirements for public notice, the evaluation of demonstration 
projects, and reports to the Secretary on the implementation of 
approved demonstrations. Form Number: CMS-10341 (OMB control number: 
0938-1162); Frequency: Yearly and quarterly; Affected Public: State, 
Local, or Tribal Governments; Number of Respondents: 48; Total Annual 
Responses: 403; Total Annual Hours: 41,847. (For policy questions 
regarding this collection contact Raven Smith at 410-786-3731.)
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Reporting 
Requirements and Corrective Action Plans Under section 1902(tt) of the 
Social Security Act; Use: The data and information in the CAP that 
states are required to report is used by CMS to document that states' 
redetermination activities are in compliance with Federal 
redetermination requirements, to identify concerns with eligibility 
renewals within a state's Medicaid program, and to inform any necessary 
programmatic changes to address unauthorized loss of coverage. CMS uses 
the information to conduct oversight of state activities and to make 
informed decisions whether to take enforcement action in the form of 
requiring the suspension of procedural terminations and/or imposing 
CMPs. Form Number: CMS-10875 (OMB control number: 0938-1462); 
Frequency: Once and on occasion; Affected Public: State, Local, or 
Tribal Governments; Number of Respondents: 8; Total Annual Responses: 
16; Total Annual Hours: 408. (For policy questions regarding this 
collection contact Abby Kahn at 410-786-4321.)
    3. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Application for 
Enrollment in Medicare Part B (Medical Insurance); Use: Medicare Part B 
is a voluntary program, financed from premium payments by enrollees, 
together with contributions from funds appropriated by the Federal 
government. The Social Security Act (the Act) at section 226(a) 
provides that individuals who are age 65 or older and eligible for, or 
entitled to, Social Security or Railroad Retirement Board (RRB) 
benefits shall be entitled to premium-free Part A upon filing an 
application for such benefits. Section 1836 of the Act permits 
individuals with Medicare premium-free Part A to enroll in Part B. The 
CMS-40B provides the necessary information to determine eligibility and 
to process the beneficiary's request for enrollment for Medicare Part B 
coverage. This form is only used for enrollment by beneficiaries who 
already have Part A, but not Part B.
    Form CMS-40B is completed by the person with Medicare or 
occasionally by an SSA representative using information provided by the 
Medicare enrollee during an in-person interview. The form is owned by 
CMS, but not completed by

[[Page 86342]]

CMS staff. SSA processes Medicare enrollments on behalf of CMS. Form 
Number: CMS-40B (OMB control number: 0938-1230); Frequency: Once; 
Affected Public: Individuals and Households; Number of Respondents: 
1,184,546; Total Annual Responses: 1,184,546; Total Annual Hours: 
292,820. (For policy questions regarding this collection contact Carla 
Patterson at 410-786-8911 or <a href="/cdn-cgi/l/email-protection#eba88a99878ac5bb8a9f9f8e99988485ab888698c5838398c58c849d"><span class="__cf_email__" data-cfemail="3576544759541b655441415047465a5b755658461b5d5d461b525a43">[email protected]</span></a>.)
    4. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Application for 
Medicare Part A and Part B Special Enrollment Period (Exceptional 
Circumstances); Use: Section 1837(m) of the Social Security Act (the 
Act) provides authority for the Secretary of the Department of Health 
and Human Services to establish SEPs for individuals who are eligible 
to enroll in Medicare and meet such exceptional conditions as the 
Secretary may provide.
    CMS provides SEPs for individuals experiencing an exceptional 
circumstance to enroll in Medicare premium Part A and Part B. To 
utilize these SEPs, an individual would have to submit an enrollment 
request via the form CMS-10797. The form is used by individuals who 
have missed an enrollment period due to an exceptional circumstance to 
enroll in Part A and/or Part B. Individuals complete the form and 
submit it to SSA to complete the enrollment.
    The application form provides the necessary information to 
determine eligibility and to process the beneficiary's request for 
enrollment in premium Part A or Part B due to an exceptional 
circumstance. The form is only used for enrollment by beneficiaries who 
could not enroll during another enrollment period due to an exceptional 
circumstance. Form Number: CMS-10797 (OMB control number: 0938-1426); 
Frequency: Once; Affected Public: Individuals and Households, Business 
or other for-profits, Not-for-profits institutions; Number of 
Respondents: 34,612; Total Annual Responses: 34,612; Total Annual 
Hours: 19,901. (For policy questions regarding this collection contact 
Carla Patterson at 410-786-8911 or <a href="/cdn-cgi/l/email-protection#400321322c216e102134342532332f2e00232d336e2828336e272f36"><span class="__cf_email__" data-cfemail="b8fbd9cad4d996e8d9ccccddcacbd7d6f8dbd5cb96d0d0cb96dfd7ce">[email protected]</span></a>.)
    5. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Request for 
Enrollment in Supplementary Medical Insurance (SMI); Use: Section 1836 
of the Social Security Act, and CMS regulations at 42 CFR 407.10, 
provide the eligibility requirements for enrollment in Part B for 
individuals aged 65 and older who are not entitled to premium-free Part 
A. The individual must be a resident of the United States, and either a 
U.S. Citizen or an alien lawfully admitted for permanent residence that 
has lived in the US continually for 5 years.
    Part B is a voluntary program and is financed from premium payments 
by enrollees together with contributions from funds appropriated by the 
Federal government. All individuals age 65 or older who are entitled to 
Part A can enroll in Part B. There are some individuals, age 65 and 
over who are not entitled to or eligible for premium-free Part A. These 
individuals may, however, enroll in Part B only.
    The CMS-4040 solicits the information that is used to determine 
entitlement for individuals who meet the requirements in section 1836 
as well as the entitlement of the applicant or their spouses to an 
annuity paid by OPM for premium deduction purposes. The application 
follows the application questions and requirements used by SSA. This is 
done not only for consistency purposes but to comply with other title 
II and title XVIII requirements because eligibility to title II 
benefits and free Part A under title XVIII must be ruled out in order 
to qualify for enrollment in Part B only. Form Number: CMS-4040 (OMB 
control number: 0938-0245); Frequency: Once; Affected Public: 
Individuals and Households, Business or other for-profits, Not-for-
profits institutions; Number of Respondents: 48,642; Total Annual 
Responses: 48,642; Total Annual Hours: 12,161. (For policy questions 
regarding this collection contact Carla Patterson at 410-786-8911 or 
<a href="/cdn-cgi/l/email-protection#1556746779743b457461617067667a7b557678663b7d7d663b727a63"><span class="__cf_email__" data-cfemail="6f2c0e1d030e413f0e1b1b0a1d1c00012f0c021c4107071c41080019">[email protected]</span></a>.)

William N. Parham, III,
Director, Division of Information Collections and Regulatory Impacts, 
Office of Strategic Operations and Regulatory Affairs.
[FR Doc. 2024-25148 Filed 10-29-24; 8:45 am]
BILLING CODE 4120-01-P


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