[Federal Register Volume 61, Number 95 (Wednesday, May 15, 1996)]
[Notices]
[Pages 24501-24502]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-12104]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
AGENCY: Health Care Financing Administration.
In compliance with the Paperwork Reduction Act of 1995 (44 U.S.C.
3501 et seq.), the Health Care Financing
[[Page 24502]]
Administration (HCFA), Department of Health and Human Services, has
submitted to the Office of Management and Budget (OMB) the following
proposals 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 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: Reinstatement, without
change, of a previously approved collection for which approval has
expired; Title of Information Collection: Medicare and Medicaid
Disclosure of Ownership and Control Interest Statement; Form No.: HCFA-
1513; Use: The information provided on this form is used by State
agencies and HCFA regional offices to determine whether providers meet
the eligibility requirements for Titles 18 and 19 (Medicare and
Medicaid) and for grants under Titles 5 and 20. Review of ownership and
control is particularly necessary to prohibit ownership and control for
individuals excluded under Federal Fraud statutes; Frequency: On
Occasion; Affected Public: Business or other for profit, not-for-
profit; Number of Respondents: 60,000; Total Annual Hours: 30,000.
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Evaluation of the
Program of All-Inclusive Care for the Elderly (PACE) Demonstration;
Form No.: HCFA-R-165; Use: This survey will collect data on functional
status, service utility, and out-of-pocket costs, and satisfaction for
a sample of applicants to the PACE program. This information will be
analyze the decision to participate in PACE and the impact of the
program; Frequency: Semi-annually; Affected Public: Individuals and
households; Number of Respondents: 1,833; Total Annual Hours: 3,745.
To obtain copies of the supporting statement for the proposed
paperwork collections referenced above, access HCFA's WEB SITE ADDRESS
at http://www.ssa.gov/hcfa/hcfahp2.html , or to obtain the supporting
statement and any related forms, 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 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
10235, Washington, D.C. 20503.
Dated: May 7, 1996.
Kathleen B. Larson,
Director, Management Planning and Analysis Staff, Office of Financial
and Human Resources, Health Care Financing Administration.
[FR Doc. 96-12104 Filed 5-14-96; 8:45 am]
BILLING CODE 4120-03-P
