Agency Information Collection Activities: Proposed Collection; Comment Request

AGENCY:

Centers for Medicare and Medicaid Services.

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: Public Reporting on Quality Outcomes National Survey of Hospital Executives (“PRO QUO”); Use: CMS seeks to survey hospitals quality improvement executives in spring 2005 to assess awareness of CMS Hospital Quality Initiatives and related publicity, and to assess impact of these initiatives on hospitals and their quality improvement programs. Findings will be used to enhance CMS programs to assist hospitals in quality improvement. Form Number: CMS-10128 (OMB#: 0938-NEW); Frequency: Once; Affected Public: Not-for-profit institutions and business or other for-profit; Number of Respondents: 1,600; Total Annual Responses: 1,600; Total Annual Hours: 792.

2. Type of Information Collection Request: New collection; Title of Information Collection: Phone Surveys of Product/Service for Medicare Payment Validation and Supporting Regulations in 42 CFR 405.502; Form No.: CMS-10112 (OMB# 0938-NEW); Use: The Phone Surveys of Product/Service for Medicare Payment Validation will be used to identify specific products/services provided to Medicare beneficiaries and the costs associated with the provision of those products/services. The information collected will be used to validate the Medicare payment amounts for those products/services and institute revisions of payment amounts where necessary. The respondents will be the companies that have provided the product/service under review to Medicare beneficiaries.; Frequency: On occasion; Affected Public: Business or other for-profit; Number of Respondents: 2,000; Total Annual Responses: 2,000; Total Annual Hours: 16,000.

3. Type of Information Collection Request: Extension of a currently approved collection; Title of Information Collection: Assessing the Division of Beneficiary Inquiry Customer Service's Performance for Written Responses; Form No.: CMS-10068 (OMB# 0938-0894); Use: The Division of Beneficiary Inquiry Customer Service (DBICS) will collect information several times during FY ’04-’05 to assess the customer service provided via written responses. DBICS will conduct the written survey through mailings that will accompany actual responses. The envelopes will be sent by Release Clerks so that the actual writer has no knowledge that a particular response is being rated.; Frequency: Quarterly; Affected Public: Individuals or households; Number of Respondents: 2,872; Total Annual Responses: 2,872; Total Annual Hours: 287.

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.

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: Melissa Musotto, Room C5-14-03, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.