[Federal Register Volume 59, Number 184 (Friday, September 23, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-23282]


[[Page Unknown]]

[Federal Register: September 23, 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, 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: Extension; Title of Information Collection: 
Methodology for Estimating Waiver Costs of Health Care Financing 
Administration Demonstration Projects; Form No.: HCFA-482; Use: The 
information collection is intended to provide guidance to individuals 
responsible for the preparation of waiver cost estimates for HCFA 
demonstrations. These estimates are used in analysis of potential costs 
and benefits associated with implementing a proposed policy. Frequency: 
Annually; Respondents: Small businesses or organizations, State or 
local governments, businesses or other for profit, nonprofit 
institutions; Estimated Number of Responses: 50; Average Hours Per 
Response: 80; Total Estimated Burden Hours: 4,000.
    2. Type of Request: Reinstatement; Title of Information Collection: 
Medicare Collection of Medical Information on Home Health Service-
Intermediary Request for Medical Information on Claims to be Processed; 
Form Nos.: HCFA-485, -486, -487, -488; Use: This information is used by 
the fiscal intermediaries to assure that reimbursement is made to home 
health agencies only for services that are covered under Medicare Part 
A or Part B. The medical information contained in these forms and other 
medical records describes the patient and level of medical needs and/or 
services provided. These records are submitted with the claims or as 
requested; Frequency: On occasion; Respondents: Businesses or other for 
profit, and small businesses or organizations; Estimated Number of 
Responses: 6,804,000 (reporting), 6,800 (recordkeeping); Average Hours 
Per Response: .25 (reporting), 250 (recordkeeping); Total Estimated 
Burden Hours: 3,090,000.
    3. Type of Request: Reinstatement; Title of Information Collection: 
End Stage Renal Disease (ESRD) Application and Survey and Certification 
Report; Form No.: HCFA-3427; Use: Part I of this form is a facility 
identification and screening measurement used to initiate the 
certification and recertification of ESRD facilities. Part II is 
completed by the Medicaid/Medicare State survey agency to determine 
facility compliance with ESRD conditions for coverage; Frequency: 
Annually; Respondents: State or local governments; Estimated Number of 
Responses: 1,253; Average Hours Per Response: 2.41; Total Estimated 
Burden Hours: 3,019.7.
    4. Type of Request: Revision; Title of Information Collection: 
Medicaid Drug Rebate Program--Manufacturers; Form No.: HCFA-367; Use: 
The Omnibus Budget Reconciliation Act of 1990 requires drug 
manufacturers to enter into and have in effect a rebate agreement with 
the Federal Government for States to receive funding for drugs 
dispensed to Medicaid recipients; Frequency: Quarterly; Respondents: 
Businesses or other for profit; Estimated Number of Responses: 461; 
Average Hours Per Response: 87.33; Total Estimated Burden Hours: 
40,260.
    5. Type of Request: Reinstatement; Title of Information Collection: 
Municipal Health Services Cost Report; Form No.: HCFA-255; Use: In 
order to determine the cost of the clinical services being provided, it 
is necessary to determine the direct and indirect costs incurred by the 
participating clinics for the routine and ancillary cost centers. This 
form is being used to report the costs to the participating clinics 
providing the covered services, as well as to gather data to evaluate 
the demonstration; Frequency: Semiannually; Respondents: State or local 
governments; Estimated Number of Responses: 15; Average Hours Per 
Response: 34; Total Estimated Burden Hours: 510.
    6. Type of Request: New; Title of Information Collection: Survey of 
Applicants to the Program of All-inclusive Care for the Elderly; Form 
No.: HCFA-R-165; Use: This survey will collect data on functional 
status, service utilization and out-of-pocket costs, and satisfaction 
for a sample of applicants to the program. This information will be 
used to analyze the decision to participate and, potentially, the 
impact of the program; Frequency: Semiannually; Respondents: 
Individuals or households; Estimated Number of Responses: 3,727; 
Average Hours Per Response: 1.176; Total Estimated Burden Hours: 
4,382.500.
    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.

Date: September 14, 1994.
Kathleen Larson,
Acting Director, Management Planning and Analysis Staff, Office of 
Financial and Human Resources, Health Care Financing Administration.
[FR Doc. 94-23282 Filed 9-22-94; 8:45 am]
BILLING CODE 4120-03-P