[Federal Register Volume 63, Number 227 (Wednesday, November 25, 1998)]
[Notices]
[Page 65213]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-31536]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[Document Identifier: HCFA-287 & HCFA-1491]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Health Care Financing Administration, HHS.
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, 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 and 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.
(1) Type of Information Collection Request: Extension of a
currently approved collection;
Title of Information Collection: Home Office Cost Statement and
Supporting Regulations in 42 CFR Section 413.17;
Form No.: HCFA-287 (OMB# 0938-0202);
Use: Medicare law permits components of chain organizations to be
reimbursed for certain costs incurred by the Home Offices of the chain.
The Home Office Cost Statement is required by the fiscal intermediary
to verify Home Office Costs claimed by the components. This requires
that the provider include in its costs, the costs incurred by the
related organization in furnishing such services, supplies or
facilities.
Frequency: Annually;
Affected Public: Not-for-profit institutions, Business or other
for-profit;
Number of Respondents: 1,231;
Total Annual Responses: 1,231;
Total Annual Hours: 573,646.
(2) Type of Information Collection Request: Extension of a
currently approved collection;
Title of Information Collection: Request for Medicare Payment--
Ambulance and Supporting Regulations in 42 CFR Section 410.40 and
424.124;
Form No.: HCFA-1491 (OMB# 0938-0042);
Use: This form is used by physicians, suppliers, and beneficiaries
to request payment of Part B Medicare services. It is used to apply for
reimbursement for ambulance services.
Frequency: On occasion;
Affected Public: Business or other for-profit, Individuals or
households, and Not-for-profit Institutions;
Number of Respondents: 9,634,435;
Total Annual Responses: 9,634,435;
Total Annual Hours: 406,251.
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 Paperwork@hcfa.gov, or call the Reports
Clearance Office on (410) 786-1326. Written comments and
recommendations for the proposed information collections must be mailed
within 60 days of this notice directly to the HCFA Paperwork Clearance
Officer designated at the following address: HCFA, Office of
Information Services, Security and Standards Group, Division of HCFA
Enterprise Standards, Attention: Louis Blank, Room N2-14-26, 7500
Security Boulevard, Baltimore, Maryland 21244-1850.
Dated: November 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. 98-31536 Filed 11-24-98; 8:45 am]
BILLING CODE 4120-03-P
