[Federal Register Volume 59, Number 135 (Friday, July 15, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-17304]


[[Page Unknown]]

[Federal Register: July 15, 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.
    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 (Public Law 96-511).
    1. Type of Request: Extension; Title of Information Collection: 
Medicare Common Claims Form; Form No.: HCFA-1500; Use: This form is a 
standardized form for use in the Medicare/Medicaid programs to apply 
for reimbursement for covered services. Use of these forms will reduce 
the cost and administrative burdens associated with claims; Frequency: 
On occasion; Respondents: Businesses, individuals or households, state 
or local governments, small businesses or organizations; Estimated 
Number of Responses: 546,115,406; Average Hours Per Response: .13; 
Total Estimated Burden Hours: 73,325,195.
    2. Type of Request: Extension; Title of Information Collection: HMO 
Qualification Applications; Form No.: HCFA-901-1,901-2,901-3; Use: The 
forms are used as instruments through which organizations will make 
application for Federal HMO qualification status and/or to become 
eligible to negotiate a Medicare contract with the Health Care 
Financing Administration; Frequency: On occasion; Respondents: 
Businesses or other for profit, small businesses or organizations, 
State and local governments; Estimated Number of Responses: 65; Average 
Hours Per Response: 100; Total Estimated Burden Hours: 6,500. 
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.

    Dated: July 7, 1994.
Kathleen Larson,
Director, Management Planning and Analysis Staff, Office of Financial 
and Human Resources, Health Care Financing Administration.
[FR Doc. 94-17304 Filed 7-14-94; 8:45 am]
BILLING CODE 4120-03-P