Approved for
emergency use through 1/9/96 with the understanding that during the
next three months, HCFA will consult with the affected public, and
HCFA and OMB thoroughly will consider public comments recommending
alternative CMNs and less burdensome approaches to protecting the
Medicare Trust Fund from fraudulent and abusive billing practices.
This review period may lead to revisions to the CMNs and an
information collection approach targeted toward suppliers,
physicians, and DME categories most likely to engage in such
practices.
Inventory as of this Action
Requested
Previously Approved
01/31/1996
01/31/1996
6,800,000
0
0
1,130,000
0
0
0
0
0
This information is needed to
correctly process claims and insure that claims are properly paid.
These forms contain medical information necessary to make an
appropriate determination. Suppliers and physicians will complete
these forms.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
Durable Medical Equipment Regional Carrier, Certificate of Medical Necessity, Version I and Version II