[Federal Register Volume 59, Number 93 (Monday, May 16, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-11819]
[[Page Unknown]]
[Federal Register: May 16, 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 (HHS), 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: Revision; Title of Information Collection:
Medicare Uniform Institutional Provider Bill; Form No.: HCFA-1450; Use:
The 1450 is a claim form completed by institutional providers for
inpatient and outpatient services. All intermediary processed Medicare
claims are billed on the HCFA-1450; Frequency: On occasion;
Respondents: State or local governments; Estimated Number of Responses:
100,168,729; Average Hours Per Response: 5-9 minutes; Total Estimated
Burden Hours: 3,590,518.
2. Type of Request: New; Title of Information Collection: Hospice
Survey and Deficiencies Report; Form No.: HCFA-643; Use: In order to
participate in the Medicare program, a hospice must meet certain
Federal health and safety conditions of participation. This form will
be used by State surveyors to record data about a hospice's compliance
with these conditions of participation in order to initiate the
certification or recertification process. This request includes the
recently revised Hospice Interpretive Guidelines used as the basis for
the instructions for the form; Frequency: Annually; Respondents: State
or local governments, Federal agencies or employees; Estimated Number
of Responses: 1,200; Average Hours Per Response: 2.5; Total Estimated
Burden Hours: 3,000.
3. Type of Request: Extension; Title of Information Collection:
Requirement to Disclose Health Maintenance Organization (HMOs)
Financial Information to Members; Form No.: HCFA-R-97; Use: HMOs are
required to disclose specific information to members, potential
members, employees, and contractors. This rule specifies what
information can be disclosed; Frequency: Annually; Respondents:
Businesses or other for profit, nonprofit organizations; Estimated
Number of Responses: 380; Average Hours Per Response: .5; Total
Estimated Burden Hours: 190.
4. Type of Request: Reinstatement; Title of Information Collection:
Hospital Request for Certification in the Medicare/Medicaid Program;
Form No.: HCFA-1514; Use: Section 1861 of the Social Security Act
requires hospitals to be certified to participate in the Medicare/
Medicaid program. These providers must complete the Hospital Request
for Certification on the Medicare/Medicaid program form which concerns
information collection requirements and their uses; Frequency:
Annually; Respondents: State or local governments; Estimated Number of
Responses: 2,548; Average Hours Per Response: .25; Total Estimated
Burden Hours: 637.
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: May 4, 1994.
John A. Streb,
Director, Management Planning and Analysis Staff, Office of Financial
and Human Resources, Health Care Financing Administration.
[FR Doc. 94-11819 Filed 5-13-94; 8:45 am]
BILLING CODE 4120-03-P
