[Federal Register Volume 59, Number 154 (Thursday, August 11, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-19658]


[[Page Unknown]]

[Federal Register: August 11, 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.
    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: 
ESRD Beneficiary Selection; Form No.: HCFA-382; Use: This form is used 
by beneficiaries to select or change the payment method for home 
dialysis; Frequency: One-time; Respondents: Businesses, individuals or 
households, small businesses or organizations; Estimated Number of 
Responses: 3,100; Average Hours Per Response: 5 min; Total Estimated 
Burden Hours: 258.3.
    2. Type of Request: New; Title of Information Collection: Drug 
Utilization Review (Medicaid); Form No.: HCFA-R-153; Use: Information 
collection requirements contained in this regulation provide for states 
to obtain, record and maintain patient profiles. States are required to 
collect and keep records of drug utilization data from claims 
Frequency: Annually; Respondents: Businesses or other for profit, small 
businesses or organizations, State and local governments; Estimated 
Number of Responses: 3000; Average Hours Per Response: 60; Total 
Estimated Burden Hours: 669,900.
    3. Type of Request: Revised; Title of Information Collection: Home 
Health Agency (HHA) Cost Report; Form No.: HCFA-1728; Use: The form is 
completed by Home Health agencies participating in the Medicare program 
to report reimbursement for services rendered to Medicare 
beneficiaries; Frequency: Annually; Respondents: Businesses or other 
for profit, small businesses or organizations, State and local 
governments; Estimated Number of Responses: 4,824; Average Hours Per 
Response: 160; Total Estimated Burden Hours: 771,840.
    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.

    Dated: August 1, 1994.
Kathleen Larson,
Director, Management Planning and Analysis Staff, Office of Financial 
and Human Resources, Health Care Financing Administration.
[FR Doc. 94-19658 Filed 8-10-94; 8:45 am]
BILLING CODE 4120-03-P