[Federal Register Volume 61, Number 158 (Wednesday, August 14, 1996)]
[Notices]
[Pages 42257-42258]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-20668]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
Proposals Submitted for Collection of Public Comment: Submission
for OMB Review
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, 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 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. HCFA-R-107--Type of Request: Extension of a currently approved
collection; Title of Information Collection: Medicaid--Determining
Liability of Third Parties and supporting regulation 42 CFR 433.138;
Form No.: HCFA-R-0107; Use: The information collected from Medicaid
applicants and recipients as well as from State and local agencies is
necessary to determine the legal liability of third parties to pay for
medical services in lieu of Medicaid payment. Regulation 42 CFR
4333.138 requires the increase of third party resources to improve
program efficiencies and reduce Medicaid expenditures; Frequency: On
occasion; Affected Public: Federal Government and State, local, or
tribal government; Number of Respondents: Varies; Total Annual
Responses: Varies; Total Annual Hours: 171,165.
2. HCFA-R-188--Type of Information Collection Request: New
collection; Title of Information Collection: Federally Qualified Health
Center (FQHC) Survey; Form No.: HCFA-R-188; Use: This survey is needed
and will be used by HCFA to evaluate the FQHC Medicare benefit.
Respondents will be all Medicare certified FQHC's. Frequency: On
occasion; Affected Public: Not-for-profit institutions, and business or
other for-profit; Number of Respondents: 1,489; Total Annual Responses:
1,489; Total Annual Hours Requested: 496.
3. HCFA-R-193--Type of Information Collection Request: Existing
collection in use without an OMB control number; Title of Information
Collection: An Important Message from Medicare; Form No.: HCFA-R-193;
Use: Hospitals participating in the Medicare program have agreed to
distribute ``An Important Message from Medicare'' to beneficiaries
during each admission. Receiving this information will provide the
beneficiary with some ability to participate and/or initiate
discussions concerning decisions affecting Medicare coverage or payment
and about his or her appeal rights in response to any hospital's notice
to the effect that Medicare will no longer cover continued care in the
hospital. Recordkeeping: As needed; Affected Public: Individuals or
Households, Business or other for-profit; Not-for-profit institutions,
Federal Government, and State, Local or Tribal Government; Number of
Respondents: 6,700; Total Annual Responses: 11,000,000; Total Annual
Hours Requested: 183,333.
4. HCFA-R-194--Type of Information Collection Request: New
collection; Title of Information Collection: Medicare Disproportionate
Share
[[Page 42258]]
Adjustment Procedure and Criteria; Form No.: HCFA-R-194; Use:
Regulation sets up an alternative process for hospitals that choose to
have their disproportionate share adjustment statistics calculated
based on their cost reporting periods rather than the Federal fiscal
year. Frequency: On occasion; Affected Public: Business or other for-
profit, and Not-for-profit institutions; Number of Respondents: 100;
Total Annual Responses: 100; Total Annual Hours Requested: 100.
5. HCFA-319--Type of Request: Reinstatement, without change, of a
previously approved collection for which approval has expired; Title of
Information Collection: State Medicaid Eligibility Quality Control
Sample Selection Lists; Form No.: HCFA-319; Use: The State MEQC
sampling list is necessary for regional offices to control and track
State MEQC reviews. The sample selection lists contain identifying
information on Medicaid beneficiaries. Frequency: Monthly; Affected
Public: State, local, or tribal government; Number of Respondents: 55;
Total Annual Hours: 5,280.
6. HCFA-856--Type of Information Collection Request: New
Collection; Title of Information Collection: National Payer Identifier
(PAYER-ID); Form No.: HCFA-856; Use: The PAYER-ID will allow payers of
health care claims to be identified by a unique numeric identifier.
PAYER-ID numbers will be assigned, but not limited to the following
groups: Medicare, Medicaid, VA, Public Health Service, large employers
and unions, HMOs, large insurers, etc.; Frequency: One time
(reporting); Affected Public: Not for profit institutions, business or
other for profit, Federal government, State, local or tribal
government; Number of Respondents: 85,000; Total Annual Responses:
85,000. Total Annual Hours: 85,000.
To request copies of the proposed paperwork collection referenced
above, E-mail your request, including your address, to
Paperwork@hcfa.gov, or call the Reports Clearance Office on (410) 786-
4193. 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: August 6, 1996.
Edwin J. Glatzel,
Director, Management Planning and Analysis Staff, Office of Financial
and Human Resources.
[FR Doc. 96-20668 Filed 8-13-96; 8:45 am]
BILLING CODE 4120-03-P
