[Federal Register Volume 59, Number 23 (Thursday, February 3, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-2425]
[[Page Unknown]]
[Federal Register: February 3, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
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, has submitted to OMB the following proposals
for the collection of information in compliance with the Paperwork
Reduction Act (Pub. L. 96-511).
1. Type of Request: New collection; Title of Information
Collection: Evaluation of the Medicare Case Management Demonstration;
Form No.: HCFA-161; Use: To assess the impact of case management for
patients with high cost conditions on quality of care, satisfaction
with care, and use and cost of services not covered by Medicare;
Frequency: One time; Respondents: Individuals or households; Estimated
Number of Responses: 1,800; Average Hours Per Response: .28; Total
Estimated Burden Hours: 504.
2. Type of Request: New Collection; Title of Information
Collection: Evaluation of the Medicaid Uninsured Demonstrations; Form
No.: HCFA-R-160; Use: Telephone surveys of individual purchasers and
employers offering the demonstration insurance package and comparison
group members. Surveys will collect information on demographic
characteristics, prior insurance coverage, health status, access to
care, and use of services, as well as, employer reasons for
participating and their experience with the demonstration; Frequency:
Annually; Respondents: Individuals or households; Estimated Number of
Responses: Individuals (2,002), Employers (196); Average Hours Per
Response: Individuals (.42), Employers (.25); Total Estimated Burden
Hours: 1,508.
3. Type of Request: Reinstatement; Title of Information Collection:
Internal Revenue Service (IRS), Social Security Administration (SSA),
and HCFA Data Match; Form No.: HCFA-R-137; Use: Employers identified
through a match of IRS, SSA, and Medicare records will be contacted
concerning group health plan coverage of identified individuals to
ensure compliance with Medicare Secondary Payor provisions; Frequency:
Annually; Respondents: Nonprofit organizations, Federal agencies or
employees, businesses or other for profit; Estimated Number of
Responses: 423,095; Average Hours Per Response: 5.8560843; Total
Estimated Burden Hours: 2,477,680.
4. Type of Request: Extension; Title of Information Collection:
Analysis of Malpractice Premium Data; Form No.: HCFA-R-143; Use: Survey
of physician owned medical liability insurers for use in computing the
input component of the physician liability component of the Geographic
Practice Cost Index and the Medicare Economic Index; Frequency:
Annually; Respondents: State or local governments, Small businesses or
organizations, Nonprofit organizations; Estimated Number of Responses:
Reporting (544), Recordkeeping (68); Average Hours Per Response:
Reporting (.25), Recordkeeping (1); Total Estimated Burden Hours: 204.
5. Type of Request: Reinstatement; Title of Information Collection:
Emergency & Foreign Hospital Services--Beneficiary Statement in
Canadian Travel Claims; Form No.: HCFA-R-96; Use: In Canadian travel
claims, a statement is required from the beneficiary indicating point
of entry into Canada; route being traveled at time of emergency, and an
explanation of any deviation from intended route or nonroutine
stopover. The intermediary uses this information to determine if the
beneficiary was traveling between Alaska and another State through
Canada by the most direct route without unreasonable delay to acquire
medical care and thus, entitled to benefits; Frequency: On occasion;
Respondents: Individuals or households; Estimated Number of Responses:
1,700; Average Hours Per Response: .25; Total Estimated Burden Hours:
425. (recordkeeping).
6. Type of Request: Revision; Title of Information Collection:
Survey Report Form; Form No.: HCFA-1557; Use: This survey form is an
instrument used by the State agency to record data collected in order
to determine compliance with Clinical Laboratory Improvement
Amendments. This information is needed for laboratory certification and
recertification; Frequency: Biennially; Respondents: State or local
governments, Businesses or other for profit, Federal agencies or
employees, Small businesses or organizations; Estimated Number of
Responses: 31,200; Average Hours Per Response: .54; Total Estimated
Burden Hours: 16,848. (recordkeeping).
7. Type of Request: Extension; Title of Information Collection:
Medicaid Management Information System (MMIS); Form No.: HCFA-R-4; Use:
The MMIS is a State operated, federally mandated, computer system used
for automated Medicaid claims processing and information retrieval for
program management. Data elements represent the federally imposed
recordkeeping requirements of MMIS; Frequency: Annually; Respondents:
State or local governments; Estimated Number of Responses: 48; Average
Hours Per Response: 45,965; Total Estimated Burden Hours: 2,206,320.
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: January 26, 1994.
John A. Streb,
Director, Management Planning and Analysis Staff, Office of Budget and
Administration, Health Care Financing Administration.
[FR Doc. 94-2425 Filed 2-2-94; 8:45 am]
BILLING CODE 4120-03-P
