Notice2023-12396
Agency Information Collection Activities: Submission for OMB Review; Comment Request
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
June 12, 2023
Issuing agencies
Health and Human Services DepartmentCenters for Medicare & Medicaid Services
Abstract
The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, and to allow a second opportunity for public comment on the notice. Interested persons are invited to send comments regarding the burden estimate or any other aspect of this collection of information, including the necessity and utility of the proposed information collection for the proper performance of the agency's functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection techniques or other forms of information technology to minimize the information collection burden.
Full Text
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<title>Federal Register, Volume 88 Issue 112 (Monday, June 12, 2023)</title>
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[Federal Register Volume 88, Number 112 (Monday, June 12, 2023)]
[Notices]
[Pages 38056-38057]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2023-12396]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-4040 and CMS-R-297]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
AGENCY: Centers for Medicare & Medicaid Services, Health and Human
Services (HHS).
ACTION: Notice.
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SUMMARY: The Centers for Medicare & Medicaid Services (CMS) is
announcing an opportunity for the public to comment on CMS' intention
to collect information from the public. Under the Paperwork Reduction
Act of 1995 (PRA), federal agencies are required to publish notice in
the Federal Register concerning each proposed collection of
information, including each proposed extension or reinstatement of an
existing collection of information, and to allow a second opportunity
for public comment on the notice. Interested persons are invited to
send comments regarding the burden estimate or any other aspect of this
collection of information, including the necessity and utility of the
proposed information collection for the proper performance of the
agency's functions, the accuracy of the estimated burden, ways to
enhance the quality, utility, and clarity of the information to be
collected, and the use of automated collection techniques or other
forms of information technology to minimize the information collection
burden.
DATES: Comments on the collection(s) of information must be received by
the OMB desk officer by July 12, 2023.
ADDRESSES: Written comments and recommendations for the proposed
information collection should be sent within 30 days of publication of
this notice to <a href="http://www.reginfo.gov/public/do/PRAMain">www.reginfo.gov/public/do/PRAMain</a>. Find this particular
information collection by selecting ``Currently under 30-day Review--
Open for Public Comments'' or by using the search function.
To obtain copies of a supporting statement and any related forms
for the proposed collection(s) summarized in this notice, please access
the CMS PRA website by copying and pasting the following web address
into your web browser: <a href="https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing">https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing</a>.
FOR FURTHER INFORMATION CONTACT: William Parham at (410) 786-4669.
SUPPLEMENTARY INFORMATION: Under the Paperwork Reduction Act of 1995
(PRA) (44 U.S.C. 3501-3520), federal agencies must obtain approval from
the Office of Management and Budget (OMB) for each collection of
information they conduct or sponsor. The term ``collection of
information'' is defined in 44 U.S.C. 3502(3) and 5 CFR 1320.3(c) and
includes agency requests or requirements that members of the public
submit reports, keep records, or provide information to a third party.
Section 3506(c)(2)(A) of the PRA (44 U.S.C. 3506(c)(2)(A)) requires
federal agencies to publish a 30-day notice in the Federal Register
concerning each proposed collection of information, including each
proposed extension or reinstatement of an existing collection of
information, before submitting the collection to OMB for approval. To
comply with this requirement, CMS is publishing this notice that
summarizes the following proposed collection(s) of information for
public comment:
1. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Request for
Enrollment in Supplementary Medical Insurance (SMI); Use: CMS
regulations 42 CFR 407.11 lists the CMS-4040 as the application to be
used by individuals who are not eligible for monthly Social Security/
Railroad Retirement Board benefits or free Part A. The CMS-4040
solicits the information that is used to determine entitlement for
individuals who meet the requirements in section 1836 as well as the
entitlement of the applicant or their spouses to an annuity paid by OPM
for premium deduction purposes. The application follows the application
questions and requirements used by SSA. This is done not only for
consistency purposes but to comply with other Title II and Title XVIII
requirements because eligibility to Title II benefits and free Part A
under Title XVIII must be ruled out in order to qualify for enrollment
in Part B only. Form Number: CMS-4040 (OMB control number: 0938-0245);
Frequency: Once; Affected Public: Individuals or households; Number of
Respondents: 42,011; Total Annual Responses: 42,011; Total Annual
Hours: 10,503. (For policy questions regarding this collection contact
Carla Patterson at 410-786-8911.)
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Request for
Employment Information; Use: The form CMS-L564, also referred to as
CMS-R-297, is used, in conjunction with form CMS-40-B, Application for
Supplementary Medical Insurance, during an individual's special
enrollment period (SEP). Completed by an employer, the CMS-L564
provides proof of an applicant's employer group health coverage. The
Social Security Administration (SSA) uses it to obtain information from
employers regarding whether a Medicare beneficiary's coverage under a
group health plan is based on current employment status. The form is
available online via <a href="http://Medicare.gov">Medicare.gov</a> and <a href="http://CMS.gov">CMS.gov</a> for individuals who are
requesting the SEP to obtain and submit to their employer for
completion. The employer must complete and sign the form, and submit it
to the individual to accompany their enrollment or late enrollment
penalty reduction request. The information on the completed form is
reviewed manually by SSA. Form Number: CMS-R-297 (OMB control number:
0938-0787); Frequency: Once; Affected Public: Individuals or
households, Business or other for-profits, Not-for-profit institutions;
Number of Respondents: 676,526; Total Annual Responses: 676,526; Total
Annual Hours: 56,355. (For policy questions regarding this collection
contact Carla Patterson at 410-786-8911.)
[[Page 38057]]
Dated: June 6, 2023.
William N. Parham, III,
Director, Paperwork Reduction Staff, Office of Strategic Operations and
Regulatory Affairs.
[FR Doc. 2023-12396 Filed 6-9-23; 8:45 am]
BILLING CODE 4120-01-P
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