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[Federal Register Volume 70, Number 184 (Friday, September 23, 2005)]
[Notices]
[Pages 55860-55861]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-19068]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document No. CMS-R-232, CMS-9042]

Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services (CMMS).
    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: Extension of a currently 
approved collection; Title of Information Collection: Medicare 
Integrity Program Organizational Conflict of Interest Disclosure 
Certificate and Supporting Regulations at 42 CFR 421.300-421.316; Form 
Number: CMS-R-232 (OMB: 0938-0723); Use: Section 1893(d)(1) of 
the Social Security Act requires CMS to establish a process for 
identifying, evaluating, and resolving conflicts of interest. CMS 
proposed a process under Section 421.310 to mandate submission of 
pertinent information regarding conflicts of interest. The entities 
providing the information will be organizations that have been awarded, 
or seek award of, a Medicare Integrity Program contract. CMS needs this 
information to assess whether contractors who perform, or who seek to 
perform, Medicare Integrity Program functions, such as medical review, 
fraud review or cost audits, have organizational conflicts of interest 
and whether any conflicts have been resolved. Frequency: Reporting--On 
occasion; Affected Public: Business or other for-profit; Number of 
Respondents: 11; Total Annual Responses: 11; Total Annual Hours: 2,200.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Request for 
Accelerated Payments and Supporting Regulations in 42 CFR, sections 
412.116, 412.632, 413.64, 413.350, and 484.245; Form Number: CMS-9042 
(OMB: 0938-0269); Use: Section 1815(a) of the Social Security 
Act describes payment to providers of services. 42 CFR 412.116, 42 CFR 
412.632, 42 CFR 413.64, 42 CFR 413.350, and 42 CFR 484.245 define the 
conditions under which accelerated payments may be requested. Sections 
2412.2 and 2412.3 of the Provider Reimbursement Manual identify the 
information that providers must supply to their intermediary to request 
an accelerated payment. A request for an accelerated payment can be 
made by a hospital, skilled nursing facility, home health agency, 
inpatient rehabilitation facility, critical access hospital, or hospice 
that is not receiving periodic interim payments. Accelerated payment 
request forms are used by fiscal intermediaries to assess a provider's 
eligibility for accelerated payments. Frequency: Reporting--On 
occasion; Affected Public: Business or

[[Page 55861]]

other for-profit, Not-for-profit institutions; Number of Respondents: 
822; Total Annual Responses: 822; Total Annual Hours: 411.
    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/regulations/pra/, or E-mail 
your request, including your address, phone number, OMB number, and CMS 
document identifier, to [email protected], 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 November 22, 2005. CMS, Office of Strategic 
Operations and Regulatory Affairs, Division of Regulations Development, 
Attention: Bonnie L. Harkless, Room C4-26-05, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850.

    Dated: September 15, 2005.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 05-19068 Filed 9-22-05; 8:45 am]
BILLING CODE 4120-01-P
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