[Federal Register Volume 59, Number 198 (Friday, October 14, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-25454]
[[Page Unknown]]
[Federal Register: October 14, 1994]
Public Information Collection Requirements Submitted to the
Office of Management and Budget (OMB) for Clearance
AGENCY: Health Care Financing Administration, HHS.
The Health Care Financing Administration (HCFA), Department of
Health and Human Services (HHS), has submitted to OMB the following
proposals for the collection of information in compliance with the
Paperwork Reduction Act (Public Law 96-511).
1. Type of Request: Reinstatement; Title of Information Collection:
Outpatient Rehabilitation Provider Cost Report; Form No.: HCFA-2088;
Use: The information collection is used to determine Medicare
reimbursement for outpatient services rendered to Medicare
beneficiaries; Frequency: Annually; Respondents: Businesses or other
for profit; Estimated Number of Responses: 2,050 (reporting), 2,050
(recordkeeping); Average Hours Per Response: 10 (reporting), 90
(recordkeeping); Total Estimated Burden Hours: 205,000.
2. Type of Request: Reinstatement; Title of Information Collection:
Skilled Nursing Facility and Skilled Nursing Facility Care Complex Cost
Report; Form No.: HCFA-2540; Use: The cost report is used by
freestanding skilled nursing facilities to submit annual information to
achieve a settlement of costs for health care services rendered to
Medicare beneficiaries; Frequency: Annually; Respondents: State and
local governments, nonprofit institutions, and small businesses or
organizations; Estimated Number of Responses: 7,000 (reporting), 7,000
(recordkeeping); Average Hours Per Response: 64 (reporting), 132
(recordkeeping); Total Estimated Burden Hours: 1,372,000.
3. Type of Request: Reinstatement; Title of Information Collection:
Criteria for Medicare Coverage of Adult Heart Transplants; Form No.:
HCFA-R-106; Use: Medicare participating hospitals must file an
application to be approved for coverage and payment of adult heart
transplants performed on Medicare beneficiaries; Frequency: Annually;
Respondents: Nonprofit institutions and small businesses or
organizations; Estimated Number of Responses: 8 (reporting), 73
(recordkeeping); Average Hours Per Response: 100 (reporting), 20
(recordkeeping); Total Estimated Burden Hours: 2,260.
4. Type of Request: Reinstatement; Title of Information Collection:
State Drug Rebate (Medicaid); Form No.: HCFA-368, HCFA-R-144; Use: The
Omnibus Budget Reconciliation Act of 1990 requires State Medicaid
agencies to report to drug manufacturers and HCFA on the drug
utilization for their State and the amount of rebate to be paid by the
manufacturers; Frequency: Quarterly; Respondents: State and local
governments; Estimated Number of Responses: 51; Average Hours Per
Response: 5 States, 1 hour (administrative data reports), 51 States, 30
hours x 4 quarters; Total Estimated Burden Hours: 6,125.
5. Type of Request: Reinstatement; Title of Information Collection:
Skilled Nursing Facility Prospective Payment Cost Report; Form No.:
HCFA-2540S-87; Use: This form is to be used by skilled nursing
facilities with less than 1,500 Medicare patient days, at their option,
to report costs incurred for providing services to Medicare patients;
Frequency: Annually; Respondents: Nonprofit institutions and small
businesses or organizations; Estimated Number of Responses: 1,441
(reporting), 1,441 (recordkeeping); Average Hours Per Response: 14
(reporting), 85 (recordkeeping); Total Estimated Burden Hours: 142,659.
6. Type of Request: Revision to currently approved collection;
Title of Information Collection: Organ Procurement Agency/
Histocompatibility Laboratory Statement of Reimbursable Costs; Form
No.: HCFA-216; Use: This form is used by Organ Procurement Agency/
Histocompatibility Labs to report their health care costs to determine
amounts reimbursable for services furnished to Medicare beneficiaries;
Frequency: Annually; Respondents: Businesses or other for profit and
nonprofit institutions; Estimated Number of Responses: 104; Average
Hours Per Response: 1; Total Estimated Burden Hours: 4,680.
7. Type of Request: Revision to currently approved collection;
Title of Information Collection: Information Collection Requirements in
405.2112, 405.2123, 405.2136, 405.2137, 405,2138, 405.2139, 405.2140,
and 405.2171; Form No.: HCFA-R-52; Use: This information collection is
used to ensure proper distribution and effective utilization of end
stage renal disease treatment sources while maintaining and improving
the efficient delivery of care by physicians and facilities; Frequency:
Annually; Respondents: Nonprofit institutions and small businesses or
organizations; Estimated Number of Responses: 2,321; Average Hours Per
Response: 37.52; Total Estimated Burden Hours: 87,094.
8. Type of Request: Revision to currently approved collection;
Title of Information Collection: Ambulatory Surgical Center Conditions
for Coverage; Form No.: HCFA-R-54; Use: This information collection is
designed to ensure that each ambulatory surgical center facility has a
properly trained staff and adequate physical environment to provide the
appropriate type and level of care for that type of facility;
Frequency: Three years (recordkeeping); Respondents: Small businesses
or organizations, State or local governments; Estimated Number of
Responses; 1,644; Average Hours Per Response: 10; Total Estimated
Burden Hours: 16,640.
9. Type of Request: Revision to currently approved collection;
Title of Information Collection: Home and Community Based Services:
Waiver Requirements; Form No.: HCFA-8003; Use: Under a Secretarial
waiver, States may offer a wide array of home and community based
services to individuals who otherwise would require
institutionalization. States requesting a waiver must provide certain
assurances, documentation, and cost/utilization estimates; Frequency:
Three years; Respondents: State and local governments; Estimated Number
of Responses: 140; Average Hours Per Response: 2.8; Total Estimated
Burden Hours: 12,600.
Additional Information or Comments: Call the Reports Clearance
Office on (410) 966-5536 for copies of the clearance request packages.
Written comments and recommendations for the proposed information
collections should be sent within 30 days of this notice directly to
the OMB Desk Officer designated at the following address: OMB Human
Resources and Housing Branch, Attention: Allison Eydt, New Executive
Office Building, Room 3001, Washington, DC 20503.
Dated: October 6, 1994.
Kathleen Larson,
Acting Director, Management Planning and Analysis Staff, Office of
Financial and Human Resources, Health Care Financing Administration.
[FR Doc. 94-25454 Filed 10-13-94; 8:45 am]
BILLING CODE 4120-03-M
