Federal Register / Vol. 70, No. 231 / Friday, December 2, 2005 / Notices 72305 

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#: 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-forprofit, 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#: 

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-forprofit, 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 Paperwork@cms.hhs.gov, 

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 

DEPARTMENT OF HOMELAND 

SECURITY 

Federal Emergency Management 

Agency 

RIN 1660–ZA10 

Application Period for the Assistance 

Program Under the 9/11 Heroes Stamp 

Act of 2001 

AGENCY: United States Fire 

Administration (USFA), Federal 

Emergency Management Agency, 

Department of Homeland Security. 

ACTION: Notice. 

SUMMARY: The 9/11 Heroes Stamp Act of 

2001 directed the United States Postal 

Service to issue a semipostal stamp and 

distribute the proceeds through the 

Federal Emergency Management Agency 

to the families of emergency relief 

personnel killed or permanently 

disabled while serving in the line of 

duty in connection with the terrorist 

attacks against the United States on 

September 11, 2001. This notice 

announces the application period for 

the Assistance Program Under the 9/11 

Heroes Stamp Act of 2001. 

DATES: The application period for the 

Assistance Program Under the 9/11 

Heroes Stamp Act of 2001 starts on 

December 2, 2005 and closes on March 

29, 2006. 

FOR FURTHER INFORMATION CONTACT: Tom 

Olshanski, Heroes Stamp, USFA, 

National Emergency Training Center 

(NETC), 16825 South Seton Avenue, 

Emmitsburg, MD 21727, or call 1–866–

887–9107, or send e-mail to FEMAHeroesStamp@dhs.gov. 

SUPPLEMENTARY INFORMATION: The 9/11 

Heroes Stamp Act of 2001, Public Law 

107–67, sec. 652, 115 Stat. 514 (Nov. 12, 

2001) (Heroes Stamp Act), directed the 

United States Postal Service to issue a 

semipostal stamp and distribute the 

proceeds through the Federal