95-11836. Public Information Collection Requirements Submitted to the Office of Management and Budget (OMB) for Clearance

[Federal Register Volume 60, Number 95 (Wednesday, May 17, 1995)]
[Notices]
[Page 26445]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-11836]



-----------------------------------------------------------------------

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 (Public Law 96-511).
    1. Type of Request: Reinstatement; Title of Information Collection: 
Medicare/Medicaid Psychiatric Hospital Survey Data; Form No.: HCFA-724; 
Use: The collection of these data will assure an accurate data base for 
program planning and evaluation, and survey team composition for 
surveys of psychiatric hospitals. All freestanding psychiatric 
hospitals surveyed will be required to respond; Respondents: Federal 
Government, State, local, or tribal government, not-for-profit, and 
businesses or other for-profit; Number of Respondents: 350; Total 
Annual Responses: 1; Total Annual Hours Requested: 175.
    2. Type of Request: Reinstatement; Title of Information Collection: 
Hospice Request for Certification in the Medicare Program; Form No.: 
HCFA-417; Use: The Hospice Request for Certification form is the 
identification and screening form used to initiate the certification 
process and to determine if the provider has sufficient personnel to 
participate in the Medicare program; Respondents: Federal Government, 
State, local, or tribal government, not-for-profit, and businesses or 
other for-profit; Number of Respondents: 1,720; Total Annual Responses: 
1; Total Annual Hours Requested: 430.
    Additional Information or Comments: Call the Reports Clearance 
Office on [phone] 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 10235, Washington, DC 20503.
Dora B. Ferguson,
Acting Director, Management Planning and Analysis Staff, Office of 
Financial and Human Resources, Health Care Financing Administration.
[FR Doc. 95-11836 Filed 5-16-95; 8:45 am]
BILLING CODE 4120-03-P