# Emergency Clearance: Public Information Collection Requirements Submitted to the Office of Management and Budget (OMB) > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/fr%3A98-24934 ## Record - **Collection:** Federal Register - **Document type:** Notice - **Published:** September 17, 1998 - **Citation:** 63 FR 49701 ## Text DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Care Financing Administration [Document Identifier HCFA-R-257] Emergency Clearance: Public Information Collection Requirements Submitted to the Office of Management and Budget (OMB) In compliance with the requirement of section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Health Care Financing Administration (HCFA), Department of Health and Human Services (DHHS), 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 of the 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. We are, however, requesting an emergency review of the information collection referenced below. In compliance with the requirement of section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, we have submitted to the Office of Management and Budget (OMB) the following requirements for emergency review. Due to the unanticipated event and the fact that this collection of this information is needed before the expiration of the normal time limits under OMB's regulations at 5 CFR part 1320, we are requesting an emergency review. With the creation of the Medicare+Choice program, as required by the Balanced Budget Act of 1997 (Pub. L. 105-33), new provisions have been implemented to coordinate Medicare beneficiaries' choices through the Medicare+Choice organizations. Specifically, the provisions require the establishment of procedures through which Medicare+Choice elections are made and changed, including the form and manner in which such elections are made and changed, as required by section 4001 of the Balanced Budget Act (BBA) of 1997. This necessitated a need to create an additional mechanism for beneficiaries make election to disenroll to original Medicare. This also provided the opportunity to collect information on beneficiary disenrollment behavior, as the BBA provisions required the development of quality and performance measures, specifically including collection of information regarding disenrollment rates. Collection of disenrollment reason data will promote active, informed selection by beneficiaries of options as well as to conduct quality control studies. By allowing beneficiaries the ability to request the disenrollment forms from the customer teleservice representatives, HCFA will ultimately be providing the beneficiary with more flexibility and options. The purpose of this submission is to request approval of a disenrollment form that beneficiaries will be able to obtain from the Medicare+Choice toll-free number that is to be established (as required by the BBA). Such a form allows the beneficiary to disenroll from a Medicare+Choice organization to original (fee-for-service) Medicare and allows HCFA to collect information for analysis of disenrollment rates and reasons for disenrollment. The Medicare+Choice toll-free number will be operational in November 1998 and a more expedient review is needed in order for the form to be ready to provide to the beneficiaries when the call center is operational. HCFA is requesting OMB review and approval of this collection within eleven working days, with a 180-day approval period. Written comments and recommendations will be accepted from the public if received by the individual designated below, within ten working days of publication of this notice in the Federal Register. During this 180-day period, HCFA will pursue OMB clearance of this collection as stipulated by 5 CFR 1320. Type of Information Collection Request: New Collection. Title of Information Collection: Medicare+Choice Disenrollment Form. Form Nos.: HCFA-R-257. Use: The primary purpose of the new form is to receive and process the beneficiary's request for disenrollment from a Medicare+Choice plan and to return to original (fee-for-service) Medicare. The secondary purpose of the new form is to obtain the reason for the disenrollment, for analysis and reporting. Frequency: As requested by beneficiary. Affected Public: Individuals or households, Business or other for- profit, Not-for-profit institutions, and Federal government. Number of Respondents: 60,000 annually. Total Annual Responses: 20,000 in first year, 60,000 thereafter. Total Annual Hours: 3,960. To obtain copies of the supporting statement and any related forms for the proposed paperwork collections referenced above, access HCFA's Web Site address at http://www.hcfa.gov/regs/prdact95.htm, or E-mail your request, including your address, phone number, OMB number, and HCFA document identifier, to P[email protected], or call the Reports Clearance Office on (410) 786-1326. Interested persons are invited to send comments regarding the burden or any other aspect of these collections of information requirements. However, as noted above, comments on these information collection and record keeping requirements must be mailed and/or faxed to the designee referenced below, within ten working days of [[Page 49702]] publication of this collection in the Federal Register: Health Care Financing Administration, Office of Information Services, Security and Standards Group, Division of HCFA Enterprise Standards, Room N2-14-26, 7500 Security Boulevard, Baltimore, MD 21244-1850, Fax Number: (410) 786-0262, Attn: Louis Blank HCFA-R-257 and Office of Information and Regulatory Affairs, Office of Management and Budget, Room 10235, New Executive Office Building, Washington, DC 20503, Fax Number: (202) 395-6974 or (202) 395-5167, Attn: Allison Herron Eydt, HCFA Desk Officer. Dated: September 10, 1998. John P. Burke III, HCFA Reports Clearance Officer, HCFA, Office of Information Services, Security and Standards Group, Division of HCFA Enterprise Standards. [FR Doc. 98-24934 Filed 9-16-98; 8:45 am] BILLING CODE 4120-03-P --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/fr%3A98-24934. Public record. Not legal advice.