[Federal Register Volume 64, Number 92 (Thursday, May 13, 1999)]
[Notices]
[Pages 25891-25892]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-12121]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[Document Identifier: HCFA-R-243]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
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, has
submitted to the Office of Management and Budget (OMB) the following
proposal for the collection of information. Interested persons are
invited to send comments regarding the 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
[[Page 25892]]
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.
Type of Information Collection Request: New Collection.
Title of Information Collection: Medicare Agreement Application,
Health Care Prepayment Plan and Supporting Regulations in 42 CFR,
Section 417.800--.840.
Form No.: HCFA-R-243.
Use: An organization must meet certain requirements to be a Health
Care Prepayment Plan that is eligible for a Medicare 1833 agreement.
The application is the collection form used to obtain information from
an organization that would allow HCFA staff to determine compliance
with the regulations. This form includes requests for information
about: the management of the applicant organization; arrangements for
providing health care to beneficiaries; meeting Medicare requirements
for appeals, hearings, advance directives, health benefits; risk
sharing with other entities; the fiscal soundness of the applicant; the
cost budget, which forms the basis for HCFA payment; prevention of
duplicate payment; and the applicant's marketing strategy.
Frequency: Other (One time).
Affected Public: Business or other for-profit institutions, Not-
for-profit institutions, and State, Local or Tribal Governments.
Number of Respondents: 15.
Total Annual Responses: 15.
Total Annual Hours: 1,125.
To obtain copies of the supporting statement 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 and phone number, 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 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
10235, Washington, D.C. 20503.
Dated: April 7, 1999.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA, Office of Information Services,
Security and Standards Group, Division of HCFA Enterprise Standards.
[FR Doc. 99-12121 Filed 5-12-99; 8:45 am]
BILLING CODE 4120-03-P
