[Federal Register Volume 59, Number 184 (Friday, September 23, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-23282]
[[Page Unknown]]
[Federal Register: September 23, 1994]
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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 (HHS), has submitted to OMB the following
proposals for the collection of information in compliance with the
Paperwork Reduction Act (Pub. L. 96-511).
1. Type of Request: Extension; Title of Information Collection:
Methodology for Estimating Waiver Costs of Health Care Financing
Administration Demonstration Projects; Form No.: HCFA-482; Use: The
information collection is intended to provide guidance to individuals
responsible for the preparation of waiver cost estimates for HCFA
demonstrations. These estimates are used in analysis of potential costs
and benefits associated with implementing a proposed policy. Frequency:
Annually; Respondents: Small businesses or organizations, State or
local governments, businesses or other for profit, nonprofit
institutions; Estimated Number of Responses: 50; Average Hours Per
Response: 80; Total Estimated Burden Hours: 4,000.
2. Type of Request: Reinstatement; Title of Information Collection:
Medicare Collection of Medical Information on Home Health Service-
Intermediary Request for Medical Information on Claims to be Processed;
Form Nos.: HCFA-485, -486, -487, -488; Use: This information is used by
the fiscal intermediaries to assure that reimbursement is made to home
health agencies only for services that are covered under Medicare Part
A or Part B. The medical information contained in these forms and other
medical records describes the patient and level of medical needs and/or
services provided. These records are submitted with the claims or as
requested; Frequency: On occasion; Respondents: Businesses or other for
profit, and small businesses or organizations; Estimated Number of
Responses: 6,804,000 (reporting), 6,800 (recordkeeping); Average Hours
Per Response: .25 (reporting), 250 (recordkeeping); Total Estimated
Burden Hours: 3,090,000.
3. Type of Request: Reinstatement; Title of Information Collection:
End Stage Renal Disease (ESRD) Application and Survey and Certification
Report; Form No.: HCFA-3427; Use: Part I of this form is a facility
identification and screening measurement used to initiate the
certification and recertification of ESRD facilities. Part II is
completed by the Medicaid/Medicare State survey agency to determine
facility compliance with ESRD conditions for coverage; Frequency:
Annually; Respondents: State or local governments; Estimated Number of
Responses: 1,253; Average Hours Per Response: 2.41; Total Estimated
Burden Hours: 3,019.7.
4. Type of Request: Revision; Title of Information Collection:
Medicaid Drug Rebate Program--Manufacturers; Form No.: HCFA-367; Use:
The Omnibus Budget Reconciliation Act of 1990 requires drug
manufacturers to enter into and have in effect a rebate agreement with
the Federal Government for States to receive funding for drugs
dispensed to Medicaid recipients; Frequency: Quarterly; Respondents:
Businesses or other for profit; Estimated Number of Responses: 461;
Average Hours Per Response: 87.33; Total Estimated Burden Hours:
40,260.
5. Type of Request: Reinstatement; Title of Information Collection:
Municipal Health Services Cost Report; Form No.: HCFA-255; Use: In
order to determine the cost of the clinical services being provided, it
is necessary to determine the direct and indirect costs incurred by the
participating clinics for the routine and ancillary cost centers. This
form is being used to report the costs to the participating clinics
providing the covered services, as well as to gather data to evaluate
the demonstration; Frequency: Semiannually; Respondents: State or local
governments; Estimated Number of Responses: 15; Average Hours Per
Response: 34; Total Estimated Burden Hours: 510.
6. Type of Request: New; Title of Information Collection: Survey of
Applicants to the Program of All-inclusive Care for the Elderly; Form
No.: HCFA-R-165; Use: This survey will collect data on functional
status, service utilization and out-of-pocket costs, and satisfaction
for a sample of applicants to the program. This information will be
used to analyze the decision to participate and, potentially, the
impact of the program; Frequency: Semiannually; Respondents:
Individuals or households; Estimated Number of Responses: 3,727;
Average Hours Per Response: 1.176; Total Estimated Burden Hours:
4,382.500.
Additional Information or Comments: Call the Reports Clearance
Office on (410) 966-5536 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 3001, Washington, DC 20503.
Date: September 14, 1994.
Kathleen Larson,
Acting Director, Management Planning and Analysis Staff, Office of
Financial and Human Resources, Health Care Financing Administration.
[FR Doc. 94-23282 Filed 9-22-94; 8:45 am]
BILLING CODE 4120-03-P
