[Federal Register Volume 59, Number 198 (Friday, October 14, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-25454]


[[Page Unknown]]

[Federal Register: October 14, 1994]



 

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 (Public Law 96-511).
    1. Type of Request: Reinstatement; Title of Information Collection: 
Outpatient Rehabilitation Provider Cost Report; Form No.: HCFA-2088; 
Use: The information collection is used to determine Medicare 
reimbursement for outpatient services rendered to Medicare 
beneficiaries; Frequency: Annually; Respondents: Businesses or other 
for profit; Estimated Number of Responses: 2,050 (reporting), 2,050 
(recordkeeping); Average Hours Per Response: 10 (reporting), 90 
(recordkeeping); Total Estimated Burden Hours: 205,000.
    2. Type of Request: Reinstatement; Title of Information Collection: 
Skilled Nursing Facility and Skilled Nursing Facility Care Complex Cost 
Report; Form No.: HCFA-2540; Use: The cost report is used by 
freestanding skilled nursing facilities to submit annual information to 
achieve a settlement of costs for health care services rendered to 
Medicare beneficiaries; Frequency: Annually; Respondents: State and 
local governments, nonprofit institutions, and small businesses or 
organizations; Estimated Number of Responses: 7,000 (reporting), 7,000 
(recordkeeping); Average Hours Per Response: 64 (reporting), 132 
(recordkeeping); Total Estimated Burden Hours: 1,372,000.
    3. Type of Request: Reinstatement; Title of Information Collection: 
Criteria for Medicare Coverage of Adult Heart Transplants; Form No.: 
HCFA-R-106; Use: Medicare participating hospitals must file an 
application to be approved for coverage and payment of adult heart 
transplants performed on Medicare beneficiaries; Frequency: Annually; 
Respondents: Nonprofit institutions and small businesses or 
organizations; Estimated Number of Responses: 8 (reporting), 73 
(recordkeeping); Average Hours Per Response: 100 (reporting), 20 
(recordkeeping); Total Estimated Burden Hours: 2,260.
    4. Type of Request: Reinstatement; Title of Information Collection: 
State Drug Rebate (Medicaid); Form No.: HCFA-368, HCFA-R-144; Use: The 
Omnibus Budget Reconciliation Act of 1990 requires State Medicaid 
agencies to report to drug manufacturers and HCFA on the drug 
utilization for their State and the amount of rebate to be paid by the 
manufacturers; Frequency: Quarterly; Respondents: State and local 
governments; Estimated Number of Responses: 51; Average Hours Per 
Response: 5 States, 1 hour (administrative data reports), 51 States, 30 
hours  x  4 quarters; Total Estimated Burden Hours: 6,125.
    5. Type of Request: Reinstatement; Title of Information Collection: 
Skilled Nursing Facility Prospective Payment Cost Report; Form No.: 
HCFA-2540S-87; Use: This form is to be used by skilled nursing 
facilities with less than 1,500 Medicare patient days, at their option, 
to report costs incurred for providing services to Medicare patients; 
Frequency: Annually; Respondents: Nonprofit institutions and small 
businesses or organizations; Estimated Number of Responses: 1,441 
(reporting), 1,441 (recordkeeping); Average Hours Per Response: 14 
(reporting), 85 (recordkeeping); Total Estimated Burden Hours: 142,659.
    6. Type of Request: Revision to currently approved collection; 
Title of Information Collection: Organ Procurement Agency/
Histocompatibility Laboratory Statement of Reimbursable Costs; Form 
No.: HCFA-216; Use: This form is used by Organ Procurement Agency/
Histocompatibility Labs to report their health care costs to determine 
amounts reimbursable for services furnished to Medicare beneficiaries; 
Frequency: Annually; Respondents: Businesses or other for profit and 
nonprofit institutions; Estimated Number of Responses: 104; Average 
Hours Per Response: 1; Total Estimated Burden Hours: 4,680.
    7. Type of Request: Revision to currently approved collection; 
Title of Information Collection: Information Collection Requirements in 
405.2112, 405.2123, 405.2136, 405.2137, 405,2138, 405.2139, 405.2140, 
and 405.2171; Form No.: HCFA-R-52; Use: This information collection is 
used to ensure proper distribution and effective utilization of end 
stage renal disease treatment sources while maintaining and improving 
the efficient delivery of care by physicians and facilities; Frequency: 
Annually; Respondents: Nonprofit institutions and small businesses or 
organizations; Estimated Number of Responses: 2,321; Average Hours Per 
Response: 37.52; Total Estimated Burden Hours: 87,094.
    8. Type of Request: Revision to currently approved collection; 
Title of Information Collection: Ambulatory Surgical Center Conditions 
for Coverage; Form No.: HCFA-R-54; Use: This information collection is 
designed to ensure that each ambulatory surgical center facility has a 
properly trained staff and adequate physical environment to provide the 
appropriate type and level of care for that type of facility; 
Frequency: Three years (recordkeeping); Respondents: Small businesses 
or organizations, State or local governments; Estimated Number of 
Responses; 1,644; Average Hours Per Response: 10; Total Estimated 
Burden Hours: 16,640.
    9. Type of Request: Revision to currently approved collection; 
Title of Information Collection: Home and Community Based Services: 
Waiver Requirements; Form No.: HCFA-8003; Use: Under a Secretarial 
waiver, States may offer a wide array of home and community based 
services to individuals who otherwise would require 
institutionalization. States requesting a waiver must provide certain 
assurances, documentation, and cost/utilization estimates; Frequency: 
Three years; Respondents: State and local governments; Estimated Number 
of Responses: 140; Average Hours Per Response: 2.8; Total Estimated 
Burden Hours: 12,600.
    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.

    Dated: October 6, 1994.
Kathleen Larson,
Acting Director, Management Planning and Analysis Staff, Office of 
Financial and Human Resources, Health Care Financing Administration.
[FR Doc. 94-25454 Filed 10-13-94; 8:45 am]
BILLING CODE 4120-03-M