[Federal Register Volume 63, Number 138 (Monday, July 20, 1998)]
[Notices]
[Pages 38838-38839]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-19256]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[Document Identifier: HCFA-21, 21B, 21P, 21.11A, 21E]
Agency Information Collection Activities: Proposed Collection;
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, is
publishing the following summary of proposed collections for public
comment. Interested persons are invited to send comments regarding the
burden estimate or any other aspect of this
[[Page 38839]]
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.
Type of Information Collection Request: New Collection;
Title of Information Collection: Children's Health Insurance
Program (CHIP) Budget and Expenditure System State Reporting Forms.
Form Nos.: HCFA-21, 21B, 21P, 21.11A, 21E;
Use: These forms will be used by State CHIP agencies to report CHIP
program budget projections and actual CHIP program benefits and
administrative expenditures, and the numbers of children being served
in the CHIP program, to the Health Care Financing Administration
(HCFA). The information provided by these new forms will be used by
HCFA to prepare the grant awards to States for the CHIP, to ensure that
the appropriate level of Federal payments for State expenditures under
the CHIP are made in accordance with the CHIP-related BBA legislative
provisions of 1997, and to track, monitor, and evaluate the numbers of
children being served by the CHIP.
Note: at this time Form HCFA-21E of this package is for States to
report the numbers of children, by service delivery system, that are
served in the States' CHIPs based on age categories. However, we are
continuing to work with the States to develop an appropriate format for
States to report the numbers of children, by service delivery system,
that are served in the CHIP based on Federal poverty income level
categories and under the age categories previously requested. When this
format is finalized it will be incorporated into Form HCFA-21E.
For a short description of the CHIP reporting forms, see below:
Form HCFA-21 Summary Sheet. Quarterly Children's Health
Insurance Program Statement of Expenditures for Title XXI Summary
Sheet. This form summarizes the total expenditures in the State's CHIP
reported by the State for the reporting quarter.
Form HCFA-21. Children's Health Expenditures by Type of
Service for the Title XXI Program, Expenditures in this Quarter. States
use this form to report CHIP current quarter expenditures in accordance
with services categories authorized under title XXI.
Form HCFA-21B. Children's Health Insurance Program Budget
Report for the Title XXI Program State Expenditure Plan. States use
this form to report their budget projections each quarter for their
Title XXI CHIPs for the current and budget Federal fiscal years and
broken out by quarter.
Form HCFA-21P. Children's Health Expenditures by Type of
Service for the Title XXI Program, Prior Period Adjustments. States use
this form to report CHIP prior period adjustment expenditures claimed
in the submission quarter in accordance with services categories
authorized under title XXI.
Form HCFA-21.11A. Provider-Related Donations and Health
Care Related Taxes, Fees, and Assessments Received Under Section
1903(w) for Title XXI. States use this form to report CHIP-related
State receipts of provider related donations, and health care related
taxes, fees, and assessments.
Form HCFA-21E. Children's Health Insurance Program, Number
of Children Served. States use this form to report the numbers of
children, by service delivery system, that are served in the States'
CHIPs based on age categories.
Note: HCFA is working with States to develop an appropriate
format for States to report numbers of children, by service delivery
system, that are served in the CHIP based on Federal poverty income
level categories and under the age categories previously requested.
When the format is finalized it will be incorporated into this form.
Frequency: Quarterly;
Affected Public: State and Federal government;
Number of Respondents: 56;
Total Annual Responses: 224;
Total Annual Hours: 7,840.
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 60 days of this notice directly to the HCFA Paperwork Clearance
Officer designated at the following address: HCFA, Office of
Information Services, Security and Standards Group, Division of HCFA
Enterprise Standards, Attention: John Rudolph, Room C2-26-17, 7500
Security Boulevard, Baltimore, Maryland 21244-1850.
Dated: July 9, 1998.
John P. Burke III,
HCFA Reports Clearance Officer, Division of HCFA Enterprise Standards,
Security and Standards Group, Health Care Financing Administration.
[FR Doc. 98-19256 Filed 7-17-98; 8:45 am]
BILLING CODE 4120-03-P
