[Federal Register Volume 59, Number 138 (Wednesday, July 20, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-17579]


[[Page Unknown]]

[Federal Register: July 20, 1994]


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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: Reinstatement; Title of Information Collection: 
Procedures for determining whether providers, practitioners, or other 
suppliers of services are liable for certain noncovered services; Form 
No.: HCF-A-R-77; Use: The notification provides providers, 
practitioners or suppliers with knowledge that Medicare will not pay 
for items or services mentioned in the notification. After this 
notification, any future claim for the same or similar services will 
not be paid. Frequency:  Semi-annually; Respondents: Small business or 
organizations; Estimated Number of Responses: 16,150; Average Hours Per 
Response: 5 minutes; Total Estimated Burden Hours: 1,346.
    2. Type of Request: Reinstatement; Title of Information Collection: 
Medical Review of Part B Intermediary Outpatient Therapy claims; Form 
No.: HCFA-700-701; Use: Medicare contractors require certain medical 
information to determine that requirements for Medicare coverage are 
met. The information is used to determine if billed services are 
payable in accordance with Medicare law, regulations, and guidelines. 
These services may be provided by hospitals, SNFs, CORFs, RHC, 
Hospices, ESRD facilities and Christian Science hospitals; Frequency: 
Annually; Respondents: Businesses or other for-profit, Non-profit 
institutions, and Small businesses or organizations; Estimated Number 
of Responses: 2,190,000; Average Hours Per Response: .25; Total 
Estimated Burden Hours: 547,000.
    3. Type of Request: New; Title of Information Collection: End Stage 
Renal Disease Network Cost Report Forms; Form No.: HCFA-685; Use: 
Submission of quarterly cost reports will enable HCFA to review,, 
compare and project network costs. The reports will be used as an early 
warning system to determine if the networks are in danger of exceeding 
the total cost of the contract. In addition, HCFA will be able to 
analyze line item costs; Frequency: quarterly; Respondents: Nonprofit 
institutions; Estimated Number of Responses: 72; Average Hours Per 
Response: 3; Total Estimated Burden Hours: 216.
    4. Type of Request: Revision; Title of Information Collection: 
Hospital Request for Certification in the Medicare/Medicaid Program; 
Form No.: HCFA-1514; Use: Section 1861 of the Social Security Act 
requires hospitals to be certified to participate in the Medicare and 
Medicaid programs. These providers must complete this form which 
concerns information collection requirements and their uses; Frequency: 
Annually; Respondents: State or local governments; Estimated Number of 
Responses: 2,548; Average Hours Per Response: .25; Total Estimated 
Burden Hours: 637.
    5. Type of Request: New; Title of Information Collection: End Stage 
Renal Disease Network Business Proposal Forms; Form Nos.: HCFA-684, 684 
A-J; Use: Submission of proposal information by current ESRD networks 
and other bidders according to the business proposal instructions will 
satisfy HCFA's need for meaningful, consistent and verifiable data with 
which to evaluate contract proposals; Frequency: Once every three 
years; Respondents: Nonprofit institutions; Estimated Number of 
Responses: 36; Average Hours Per Response: 30; Total Estimated Burden 
Hours: 1,080.
    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, D.C. 20503.

    Date: July 13, 1994.
Kathleen Larson,
Acting Director, Management Planning and Analysis Staff, Office of 
Financial and Human Resources, Health Care Financing Administration.
[FR Doc. 94-17579 Filed 7-19-94; 8:45 am]
BILLING CODE 4120-03-P