[Federal Register Volume 62, Number 164 (Monday, August 25, 1997)]
[Notices]
[Pages 44976-44977]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-22451]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[Document Identifier: HCFA 1763, 2088 and R-142]
Agency Information Collection Activities: Submission for OMB
Review; 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 a previously approved collection for which approval has
expired; Title of Information Collection: Request for Termination of
Premium Hospital and/or Supplementary Medical Insurance and Supporting
Regulations in 42 CFR 406.28 and 407.27; Form No.: HCFA-1763 (OMB No.
0938-0025); Use: The HCFA-1763 is used by beneficiaries to request
voluntary termination from premium hospital and/or supplementary
medical insurance. Frequency: One time only; Affected Public:
Individuals or Households and Federal Government; Number of
Respondents: 14,000; Total Annual Responses: 14,000; Total Annual
Hours: 5,833.
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Outpatient
Rehabilitation Cost Report and Supporting Regulations in 42 CFR 413.20
and 413.24 Form No.: HCFA-2088 (OMB No. 0938-0037); Use: This form is
used by Outpatient Rehabilitation Facilities to report their health
care costs to determine the amount reimbursable for services furnished
to Medicare beneficiaries. Frequency: Annually; Affected Public:
Business or other for-profit, Not-for-profit institutions, and State,
Local or Tribal Government; Number of Respondents: 4,298; Total Annual
Responses: 4,298; Total Annual Hours: 429,800.
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Information
Collection Requirements Contained in BPD-393, Examination and Treatment
for Emergency Medical Conditions and Women in Labor and Supporting
Regulations Contained in 42 CFR 488.18, 489.20 and 489.24; Document
No.: HCFA--R-142 (OMB# 0938-0667); Use: The Information Collection
Requirements contained in BPD-393, Examination and Treatment for
Emergency Medical Conditions and Women in Labor contains requirements
for hospitals to prevent them from inappropriately transferring
individuals with emergency medical conditions, as mandated by Congress.
HCFA will use this information to help assure compliance with this
mandate and protect the public. This information is not contained
elsewhere in regulations. Frequency: On occasion; Affected Public:
Individuals or Households, Not-for-profit institutions, Federal
[[Page 44977]]
Government, and State, Local or Tribal Government; Number of
Respondents: 7,000; Total Annual Responses: 7,000; Total Annual Hours
Requested: 1.
It should be noted for the HCFA-R-142, OMB 0938-0667, that based on
industry input and HCFA analysis, the applicability and burden
associated with the information collection requirements (ICR) captured
in this submission have been adjusted to properly reflect the degree of
burden associated with this collection. In particular, the ICRs
captured in this submission have been determined to be either exempt or
the burden has been deemed usual and customary in accordance with the
1995 PRA. In order to comply and properly reflect the Act, HCFA
assigned a token one-hour of burden for this submission.
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, 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 30 days of this notice directly to
the OMB desk officer: OMB Human Resources and Housing Branch,
Attention: Allison Eydt, New Executive Office Building, Room 10235,
Washington, D.C. 20503.
Dated: August 18, 1997.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA Office of Information Services,
Information Technology Investment Management Group, Division of HCFA
Enterprise Standards.
[FR Doc. 97-22451 Filed 8-22-97; 8:45 am]
BILLING CODE 4120-03-P
