[Federal Register: April 15, 2003 (Volume 68, Number 72)]
[Notices]
[Page 18212]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr15ap03-77]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare and Medicaid Services
[Document Identifier: CMS-10087, CMS-2384, CMS-10006]
Agency Information Collection Activities: Proposed Collection;
Comment Request
Agency: Centers for Medicare and Medicaid Services, HHS.
In compliance with the requirement of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the Centers for Medicare and Medicaid
Services (CMS) (formerly known as the Health Care Financing
Administration (HCFA)), Department of Health and Human Services, 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: New collection; Title of
Information Collection: Evaluation of the Illinois and Wisconsin State
Pharmacy Assistance Waivers; Form No.: CMS-10087 (OMB 0938-
NEW); Use: CMS has implemented the Pharmacy Plus Initiative to grant
waivers to states to provide pharmacy benefits to low-income elders
with incomes too high to qualify for Medicaid. This study will evaluate
the Pharmacy Plus programs initiated in the states of Illinois and
Wisconsin using a variety of methods including a descriptive program
evaluation, survey of participants, analyses of drug utilization and
costs as well as the cost impact to the Medicare and Medicaid programs;
Frequency: Other: one-time only; Affected Public: Individuals or
Households; Number of Respondents: 2,200; Total Annual Responses:
2,200; Total Annual Hours: 550.
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Third Party
Premium Billing Request; Form No.: CMS-2384; Use: The Third Party
Premium Billing Request is used as an authorization to designate that a
family member or other interested party receive the Medicare Premium
Bill and pay it on behalf of a Medicare beneficiary. Frequency: On
occasion; Affected Public: Individuals or households; Number of
Respondents: 15,000; Total Annual Hours: 6,250.
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: TWWIIA
Demonstration to Maintain Independence; Form No.: CMS-10006
(OMB 0938-0799); Use: Section 204 of the Ticket to Work and
Work Incentives Act provides for the establishment of grants for states
that develop and implement demonstration programs designed to support
working people with physical or mental impairments that without medical
assistance will result in disability. State agencies will be applying
for these grants; Frequency: Annually; Affected Public: State, Local,
or Tribal government; Number of Respondents: 56; Total Annual
Responses: 56; Total Annual Hours: 5,600.
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, access CMS's
Web site address at http://cms.hhs.gov/regulations/pra/default.asp, or
E-mail your request, including your address, phone number, OMB number,
and CMS document identifier, to Paperwork@hcfa.gov, or call the Reports
Clearance Office on (410) 786-1326. Written comments and
recommendations for the proposed information collections must be mailed
within 60 days of this notice directly to the CMS Paperwork Clearance
Officer designated at the following address: CMS, Office of Strategic
Operations and Regulatory Affairs, Division of Regulations Development
and Issuances, Attention: Dawn Willinghan, Room: C5-14-03, 7500
Security Boulevard, Baltimore, Maryland 21244-1850.
Dated: April 3, 2003.
Dawn Willinghan,
Acting Paperwork Reduction Act Team Leader, CMS Reports Clearance
Officer, Office of Strategic Operations and Strategic Affairs, Division
of Regulations Development and Issuances.
[FR Doc. 03-9115 Filed 4-14-03; 8:45 am]
BILLING CODE 4120-03-P