[Federal Register Volume 59, Number 100 (Wednesday, May 25, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-12802]


[[Page Unknown]]

[Federal Register: May 25, 1994]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
 

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: Revision; Title of Information Collection: 
Medicaid Integrated Quality Control Review Worksheet; Form No.: HCFA-
316; Use: The QC worksheet is completed by State agencies required to 
perform QC reviews for the Aid to Families with Dependent Children, 
Food Stamp, and Medicaid programs to collect case characteristics and 
quality control data; Frequency: Monthly; Respondents: State or local 
governments; Estimated Number of Responses: Integrated States: 17,700 
for Medical Assistance Only (MAO) and 1,091 for ineligible AFDC stratum 
cases; non-integrated States: 20,582 for MAO and 1,468 for ineligible 
AFDC stratum cases; Average Hours Per Response: Reporting: Integrated 
States 5.42 for MAO and 2.71 for ineligible AFDC stratum cases; non-
integrated States: 8 for MAO and 4 for ineligible AFDC stratum cases; 
Recordkeeping: Integrated States: .6 for MAO and .8 for ineligible AFDC 
stratum cases; non-intergrated States: .33 for MAO and .67 for 
ineligible AFDC stratum cases; Total Estimated Burden Hours: 269,419 
(reporting) and 19,269 (recordkeeping) for a total of 288,688.
    2. Type of Request: New; Title of Information Collection: Post 
Laboratory Survey Questionnaire--Laboratory; Form No.: HCFA-668B; Use: 
This questionnaire is an opportunity for laboratorys to evaluate the 
survey process. The form will be completed in conjunction with HCFA 
form 668A; Frequency: Biennially; Respondents: Businesses or other for 
profit, non-profit institutions, small businesses or organizations, 
Federal agencies or employees; Estimated Number of Responses: 1560; 
Average Hours Per Response: .25; Total Estimated Burden Hours: 390.
    3. Type of Request: New; Title of Information Collection: Post 
Laboratory Survey Questionnaire--Surveyor; Form No.: HCFA-668A; Use: 
This questionnaire is an opportunity for surveyor's to evaluate the 
survey process. The form will be completed in conjunction with HCFA 
form 668B; Frequency: Biennially; Respondents: Businesses or other for 
profit, State or Local governments, non-profit institutions, small 
businesses or organizations, Federal agencies or employees; Estimated 
Number of Responses: 1560; Average Hours Per Response: .25; Total 
Estimated Burden Hours: 390.
    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: May 16, 1994.
John A. Streb,
Director; Management Planning and Analysis Staff, Office of Financial 
and Human Resources, Health Care Financing Administration.
[FR Doc. 94-12802 Filed 5-24-94; 8:45 am]
BILLING CODE 4120-03-P