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0938-0685 199602-0938-004
Historical Active
HHS/CMS
Medicare Carrier Provider/Supplier Enrollment Application
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 04/19/1996
Retrieve Notice of Action (NOA) 02/15/1996
The Medicare Carrier Provider/Supplier Enrollment Application is approved for use through 4/97 under the following conditions: 1) During the next year, HCFA continues to use the AMA database for validation purposes as it did for HCFA's UPIN files. In the next submission for OMB review, HCFA evaluates the validity of provider/supplier responses in the application and the cost effectiveness of continued use of the AMA file for validation purposes; 2) HCFA designs a second enrollment application form that would collect race on a voluntary basis. This application should be used for a representative random sample of new and existing Medicare providers/suppliers. HCFA should evaluate the validity of self reported race data by comparing application responses to the AMA database; 3) HCFA makes responses to Question 4 on Professional School Information and Question 2 on Provider/Supplier Specialty voluntary. In addition, HCFA shall add a voluntary question on board certification. OMB believes that these questions should be voluntary because it is unclear how they relate to enumeration and fundamental physician identification. In the next submission for OMB review, HCFA should reevaluate the practical utility of these data elements for HCFA and other Federal agencies such as DOL; 4) In the next submission for OMB review, HCFA further should evaluate whether the burden imposed by requirements for copies of certified physician qualifications and billing agency contracts exceeds benefits to the Federal government and beneficiaries/ recipients in reduced fraud and abuse; 5) HCFA amends the section pertaining to Independent Physiological Laboratories so that it is consistent with regulations at 42 CFR 440.30. In particular, as agreed in its response to public comments, HCFA shall amend the forms to clarify that physician supervision is not mandatory. In addition, unless HCFA can present compelling arguments supporting the regulatory and analytic basis for questions per- taining to CPT codes, these questions should be deleted; 6) Reverification procedures or additional revisions to the enrollment application forms must be submitted for PRA approval; 7) prior to fielding this form, HCFA submits its Privacy Act statements and privacy assurances for proprietary materials for OMB review and approval; 8) HCFA monitors the application's questions pertaining to financial interest and ownership and reevaluates the practical utility of these questions in the next submission for OMB review; 9) pursuant to public comment, no later than 5/96 HCFA amends its burden estimate for this enrollment application; and 10) HCFA incorporates the disclosure statements mandated by the Paperwork Reduction Act of 1995 and the implementing regulations at 5 CFR 1320 into the forms/instructions.
  Inventory as of this Action Requested Previously Approved
05/31/1997 05/31/1997
160,000 0 0
240,000 0 0
0 0 0