[Federal Register Volume 61, Number 112 (Monday, June 10, 1996)]
[Notices]
[Pages 29406-29407]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-14479]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Health Care Financing Administration, HHS.
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, is
publishing the following summaries of proposed collections for public
comment. Interested persons are invited to send comments regarding this
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 previously approved collection for which approval has
expired; Title of Information Collection: End Stage Renal Disease
(ESRD) Application and Survey and Certification Report Form; Form No.:
HCFA-3427; Use: This form is a facility identification and screening
measurement tool used to initiate the certification and recertification
of ESRD facilities. The form is also completed by the Medicare/Medicaid
State survey agency to determine facility compliance with ESRD
conditions for coverage; Frequency: Annually; Affected Public: State,
local or tribal governments; Number of Respondents: 2,640; Total Annual
Hours: 2,376.
2. Type of Information Collection Request: Reinstatement, without
change, of previously approved collection for which approval has
expired; Title of Information Collection: Withholding Medicare Payments
to Recover Medicaid Overpayments; Form No.: HCFA-R-21; Use: Medicaid
providers who have received overpayments may terminate or substantially
reduce their participation in Medicaid to avoid the State's effort to
recover the amounts due. This provision establishes a mechanism for
State agencies to recoup the overpayments by withholding Medicare
payments to these providers; Frequency: On occasion; Affected Public:
State, local or tribal governments; Number of Respondents: 54; Total
Annual Hours: 81.
3. Type of Information Collection Request: Reinstatement, without
change, of previously approved collection for which approval has
expired; Title of Information Collection: Information Collection
Requirements in HSQ-110, Acquisition, Protection and Disclosure of Peer
Review Organization (PRO) Information--42 CFR 476.104, 476.105,
476.116, and 476.134; Form No.: HCFA-R-70; Use: ``Medicare Disclosure
Information, Regulatory'' The Peer Review Improvement Act of 1982
authorizes PRO's to acquire information necessary to fulfill their
duties and functions and places limits on disclosure of the
information. These requirements are on the PRO to provide notices to
the affected parties when disclosing information about them. These
requirements serve to protect the rights of the affected parties;
Frequency: On occasion; Affected Public: Business or other for profit;
Number of Respondents: 53; Total Annual Hours: 30,577.
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Survey report
Form (CLIA); Form No.: HCFA-1557; Use: Clinical Laboratory
Certification and Recertification: This survey form is an instrument
used by the State agency to record data collected in order to determine
compliance with CLIA; Frequency: Biennially; Affected Public: Business
or other for profit, not for profit institutions, Federal government
and State, local or tribal governments; Number of Respondents: 30,225;
Total Annual Hours: 16,322.
5. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Laboratory
Personnel Report (CLIA); Form No.: HCFA-209; Use: This form is used by
the State agency to determine a laboratory's compliance with personnel
qualifications under CLIA. This information is needed for a
laboratory's CLIA certification and recertification;
[[Page 29407]]
Frequency: Biennially; Affected Public: Business or other for profit,
not for profit institutions, Federal, State , local or tribal
governments; Number of Respondents: 26,250; Total Annual Hours: 13,125.
6. Type of Information Collection Request: Reinstatement, without
change, of previously approved collection for which approval has
expired; Title of Information Collection: Prepaid Health Plan Cost
Report; Form No.: HCFA-276; Use: These forms are needed to establish
the reasonable cost providing covered services to the enrolled Medicare
population of an HMO in accordance with Section 1876 of the Social
Security Act; Frequency: Quarterly, Annually; Affected Public: Business
or other for profit; Number of Respondents: 82; Total Annual Hours:
9,934.
7. Type of Information Collection Request: Reinstatement, without
change, of previously approved collection for which approval has
expired; Title of Information Collection: Medicare Credit Balance
Reporting Requirements; Form No.: HCFA-838; Use: The collection of
credit balance information is needed to ensure that millions of dollars
in improper program payments are collected. Approximately 37,600 health
care providers will be required to submit a quarterly credit balance
report that indicates the amount of improper payments they received
that are due to Medicare. The intermediaries will monitor the reports
to ensure these funds are collected; Frequency: Quarterly; Affected
Public: Not for profit institutions; Number of Respondents: 37,600;
Total Annual Hours: 902,400.
8. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Statement of
Deficiencies and Plan of Correction; Form No.: HCFA-2567-A; Use: This
Paperwork package provides information regarding deficiencies for Organ
Procurement Organizations (OPO) as well as deficiencies noted during
periodic facility and laboratory certification surveys. This
information is used to make decisions concerning OPO redesignation,
certification/recertification of health care facilities participating
in the Medicare/Medicaid Programs, and laboratories regulated by CLIA.
Frequency: Annually and Biennially; Affected Public: State, Local or
Tribal Governments, Business or other for-profit, Not-for-profit
institutions, Federal Government; Number of Respondents: 49,200; Total
Annual Responses: 98,400; Total Annual Hours Requested: 196,800.
9. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Medicare/Medicaid
Hospital Survey Report Form; Form No.: HCFA-1537; Use: Section 1861(e)
of the Social Security ACT provides that hospitals participating in
Medicare must meet specific requirements. These requirements are
presented as conditions of Participation. State agencies must determine
compliance with these conditions through the use of this report form;
Frequency: Annually; Affected Public: State, Local or Tribal
Governments; Number of Respondents: 1,322; Total Annual Hours
Requested: 4,296.50.
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, 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 must be mailed within 60 days of this notice
directly to the HCFA Paperwork Clearance Officer designated at the
following address: HCFA, Office of Financial and Human Resources,
Management Planning and Analysis Staff, Attention: John Burke, Room C2-
26-17, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.
Dated: June 3, 1996.
Kathleen B. Larson,
Director, Management Planning and Analysis Staff, Office of Financial
and Human Resources, Health Care Financing Administration.
[FR Doc. 96-14479 Filed 6-7-96; 8:45 am]
BILLING CODE 4120-03-P
