[Federal Register Volume 59, Number 192 (Wednesday, October 5, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-24665]


[[Page Unknown]]

[Federal Register: October 5, 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: Reinstatement; Title of Information Collection: 
Indirect Medical Education; Form No.: HCFA-R-64; Use: This collection 
of information on interns and residents is needed to calculate Medicare 
program payments for hospitals for the indirect costs they incur for 
medical education. Frequency: Annually; Respondents: Businesses or 
other for profit, nonprofit institutions; Estimated Number of 
Responses: 1,250; Average Hours Per Response: 3; Total Estimated Burden 
Hours: 3,750.
    2. Type of Request: Revision; Title of Information Collection: 
Psychiatric Unit Criteria Worksheet, Rehabilitation Hospital Criteria 
Worksheet, and Rehabilitation Unit Criteria Worksheet; Form Nos.: HCFA-
437, -437A, -437B; Use: These forms are necessary to verify and 
reverify that these facilities/units comply and remain in compliance 
with the exclusion criteria for the Medicare prospective payment 
system; Frequency: Annually; Respondents: Businesses or other for 
profit, nonprofit institutions, and State or local governments; 
Estimated Number of Responses: 2,349; Average Hours Per Response: .25; 
Total Estimated Burden Hours: 587.
    3. Type of Request: Reinstatement; Title of Information Collection: 
Medicare Supplier Number Application; Form No.: HCFA-192; Use: 
Legislation requires all suppliers to disclose the names of owners and 
managing employees. This form establishes a standard for that data 
collection. These data are used to identify common ownership and 
management and sanctioned individuals in the Medicare and Medicaid 
programs; Frequency: On occasion; Respondents: Businesses or other for 
profit, small businesses or organizations; Estimated Number of 
Responses: 50,000; Average Hours Per Response: .75; Total Estimated 
Burden Hours: 37,500.
    4. Type of Request: Reinstatement; Title of Information Collection: 
Requests for Medicare Payment by Municipal Health Services Program 
(MHSP) Clinics; Form No.: HCFA-127; Use: This form allows for the 15 
participating clinics to be reimbursed for services they provided to 
Medicare beneficiaries. The form permits cities participating in the 
MHSP to receive correct and timely reimbursement and expedites the 
routing and payment of bills; Frequency: Weekly; Respondents: State or 
local governments; Estimated Number of Responses: 443,000; Average 
Hours Per Response: .16; Total Estimated Burden Hours: 70,880.
    5. Type of Request: New; Title of Information Collection: 
Examination and Treatment for Emergency Medical Conditions and Women in 
Labor and 42 CFR 489.24 Essentials of Provider Agreement 
Responsibilities of Medicare Participating Hospitals in Emergency 
Cases; Form No.: HCFA-1514A/B; Use: Under Section 1867 of the Social 
Security Act, Examination and Treatment for Emergency Medical 
Conditions and Women in Labor, effective August 1986, hospitals may 
continue to participate in Medicare only if they are not out of 
compliance with its provisions. We need to provide this tool to 
surveyors to promote uniform and thorough application of the 
requirements and to gather information frequently requested by Congress 
and other interested parties regarding implementation of the statute; 
Frequency: On occasion; Respondents: Federal agencies or employees, 
nonprofit institutions, State or local governments, individuals or 
households; Estimated Number of Responses: 350; Average Hours Per 
Response: .25; Total Estimated Burden Hours: 87.5.
    6. Type of Request: New; Title of Information Collection: 
Evaluation of Patient and Physician Satisfaction With the Medicare 
Participating Heart Bypass Center Demonstration; Form No. HCFA-R-166; 
Use: This requirement provides HCFA with information to determine 
whether lowering the amount paid for heart bypass procedures 
compromises the care provided to Medicare beneficiaries; Frequency: 
One-time survey; Respondents: Individuals or households; Estimated 
Number of Responses: 840; Average Hours Per Response: .35; Total 
Estimated Burden Hours: 294.
    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: September 29, 1994.
 Kathleen Larson,
Acting Director, Management Planning and Analysis Staff, Office of 
Financial and Human Resources, Health Care Financing Administration.
[FR Doc. 94-24665 Filed 10-4-94; 8:45 am]
BILLING CODE 4120-03-P