[Federal Register Volume 59, Number 23 (Thursday, February 3, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-2425]


[[Page Unknown]]

[Federal Register: February 3, 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, 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: New collection; Title of Information 
Collection: Evaluation of the Medicare Case Management Demonstration; 
Form No.: HCFA-161; Use: To assess the impact of case management for 
patients with high cost conditions on quality of care, satisfaction 
with care, and use and cost of services not covered by Medicare; 
Frequency: One time; Respondents: Individuals or households; Estimated 
Number of Responses: 1,800; Average Hours Per Response: .28; Total 
Estimated Burden Hours: 504.
    2. Type of Request: New Collection; Title of Information 
Collection: Evaluation of the Medicaid Uninsured Demonstrations; Form 
No.: HCFA-R-160; Use: Telephone surveys of individual purchasers and 
employers offering the demonstration insurance package and comparison 
group members. Surveys will collect information on demographic 
characteristics, prior insurance coverage, health status, access to 
care, and use of services, as well as, employer reasons for 
participating and their experience with the demonstration; Frequency: 
Annually; Respondents: Individuals or households; Estimated Number of 
Responses: Individuals (2,002), Employers (196); Average Hours Per 
Response: Individuals (.42), Employers (.25); Total Estimated Burden 
Hours: 1,508.
    3. Type of Request: Reinstatement; Title of Information Collection: 
Internal Revenue Service (IRS), Social Security Administration (SSA), 
and HCFA Data Match; Form No.: HCFA-R-137; Use: Employers identified 
through a match of IRS, SSA, and Medicare records will be contacted 
concerning group health plan coverage of identified individuals to 
ensure compliance with Medicare Secondary Payor provisions; Frequency: 
Annually; Respondents: Nonprofit organizations, Federal agencies or 
employees, businesses or other for profit; Estimated Number of 
Responses: 423,095; Average Hours Per Response: 5.8560843; Total 
Estimated Burden Hours: 2,477,680.
    4. Type of Request: Extension; Title of Information Collection: 
Analysis of Malpractice Premium Data; Form No.: HCFA-R-143; Use: Survey 
of physician owned medical liability insurers for use in computing the 
input component of the physician liability component of the Geographic 
Practice Cost Index and the Medicare Economic Index; Frequency: 
Annually; Respondents: State or local governments, Small businesses or 
organizations, Nonprofit organizations; Estimated Number of Responses: 
Reporting (544), Recordkeeping (68); Average Hours Per Response: 
Reporting (.25), Recordkeeping (1); Total Estimated Burden Hours: 204.
    5. Type of Request: Reinstatement; Title of Information Collection: 
Emergency & Foreign Hospital Services--Beneficiary Statement in 
Canadian Travel Claims; Form No.: HCFA-R-96; Use: In Canadian travel 
claims, a statement is required from the beneficiary indicating point 
of entry into Canada; route being traveled at time of emergency, and an 
explanation of any deviation from intended route or nonroutine 
stopover. The intermediary uses this information to determine if the 
beneficiary was traveling between Alaska and another State through 
Canada by the most direct route without unreasonable delay to acquire 
medical care and thus, entitled to benefits; Frequency: On occasion; 
Respondents: Individuals or households; Estimated Number of Responses: 
1,700; Average Hours Per Response: .25; Total Estimated Burden Hours: 
425. (recordkeeping).
    6. Type of Request: Revision; Title of Information Collection: 
Survey Report Form; Form No.: HCFA-1557; Use: This survey form is an 
instrument used by the State agency to record data collected in order 
to determine compliance with Clinical Laboratory Improvement 
Amendments. This information is needed for laboratory certification and 
recertification; Frequency: Biennially; Respondents: State or local 
governments, Businesses or other for profit, Federal agencies or 
employees, Small businesses or organizations; Estimated Number of 
Responses: 31,200; Average Hours Per Response: .54; Total Estimated 
Burden Hours: 16,848. (recordkeeping).
    7. Type of Request: Extension; Title of Information Collection: 
Medicaid Management Information System (MMIS); Form No.: HCFA-R-4; Use: 
The MMIS is a State operated, federally mandated, computer system used 
for automated Medicaid claims processing and information retrieval for 
program management. Data elements represent the federally imposed 
recordkeeping requirements of MMIS; Frequency: Annually; Respondents: 
State or local governments; Estimated Number of Responses: 48; Average 
Hours Per Response: 45,965; Total Estimated Burden Hours: 2,206,320.
    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.

    Dated: January 26, 1994.
John A. Streb,
 Director, Management Planning and Analysis Staff, Office of Budget and 
Administration, Health Care Financing Administration.
[FR Doc. 94-2425 Filed 2-2-94; 8:45 am]
BILLING CODE 4120-03-P