[Federal Register Volume 70, Number 231 (Friday, December 2, 2005)]
[Notices]
[Page 72305]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 05-23596]



[[Page 72305]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-1500 (12-90), CMS-1490-U, CMS-1490-S, CMS-
1500 (08-05)]


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: Extension of a currently 
approved collection; Title of Information Collection: Health Insurance 
Common Claims Form and Supporting Regulations at 42 CFR Part 424, 
Subpart C; Form Number: CMS-1500 (12-90), CMS-1490-U, CMS-1490-S 
(OMB<greek-i>: 0938-0008); Use: The Form CMS-1500 answers the needs of 
many health insurers. It is the basic form prescribed by CMS for the 
Medicare program and is only accepted from physicians and suppliers 
that are excluded from the mandatory electronic claims submission 
requirements set forth in the Administrative Simplification Compliance 
Act (ASCA) Pub. L. 107-105 and the implementing regulation at 42 CFR 
424.32. The Medicaid State Agencies, CHAMPUS/TriCare, Office of 
Workers' Compensation Programs (OWCP), U.S. Railroad Retirement Board 
(RRB), Blue Cross/Blue Shield Plans, the Federal Employees Health 
Benefit Plan, and several private health plans also use it; it is the 
de facto standard ``professional'' claim form. CMS is seeking re-
approval of the CMS-1500 (12/90), CMS-1490-U, and the CMS-1490-S 
forms.; Frequency: Reporting--On occasion; Affected Public: State, 
Local, or Tribal Government, Business or other-for-profit, Not-for-
profit institutions; Number of Respondents: 902,378; Total Annual 
Responses: 957,204,707; Total Annual Hours: 46,383,364.
    2. Type of Information Collection Request: New collection; Title of 
Information Collection: Health Insurance Common Claims Form and 
Supporting Regulations at 42 CFR Part 424, Subpart C; Form Number: CMS-
1500 (08-05), CMS-1490-S (OMB<greek-i>: 0938-NEW); Use: CMS is 
simultaneously seeking approval for form CMS-1500 (08-05) and the CMS-
1500 (12-90). A concurrent approval for the two forms is needed to 
allow the industry to prepare for the conversion, i.e. computer system 
conversions and mass printing of the form CMS-1500 (08-05). The CMS-
1500 (08-05) will be accepted beginning in October, 2006. Its use will 
be mandatory in 2007. In 2007, the CMS-1500 (12-90) and the 
corresponding OMB control number will be discontinued. The Form CMS-
1500 answers the needs of many health insurers. It is the basic form 
prescribed by CMS for the Medicare program and is only accepted from 
physicians and suppliers that are excluded from the mandatory 
electronic claims submission requirements set forth in the 
Administrative Simplification Compliance Act (ASCA) Pub. L. 107-105 and 
the implementing regulation at 42 CFR 424.32. The Medicaid State 
Agencies, CHAMPUS/TriCare, Office of Workers' Compensation Programs 
(OWCP), U.S. Railroad Retirement Board (RRB), Blue Cross/Blue Shield 
Plans, the Federal Employees Health Benefit Plan, and several private 
health plans also use it; it is the de facto standard ``professional'' 
claim form.; Frequency: Reporting--On occasion; Affected Public: State, 
Local, or Tribal Government, Business or other-for-profit, Not-for-
profit institutions; Number of Respondents: 902,378; Total Annual 
Responses: 957,204,707; Total Annual Hours: 46,383,364.
    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 <a href="/cdn-cgi/l/email-protection#095968796c7b7e667b62496a647a2761617a276e667f"><span class="__cf_email__" data-cfemail="a8f8c9d8cddadfc7dac3e8cbc5db86c0c0db86cfc7de">[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 January 31, 2006.
    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.

    Dated: November 23, 2005.
Michelle Shortt,
Director, Regulations Development Group, Office of Strategic Operations 
and Regulatory Affairs.
[FR Doc. 05-23596 Filed 12-1-05; 8:45 am]
BILLING CODE 4120-01-P


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