[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] ----------------------------------------------------------------------- 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