[Federal Register Volume 59, Number 208 (Friday, October 28, 1994)]
[Unknown Section]
[Page ]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-26770]


[Federal Register: October 28, 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: New; Title of Information Collection: Medicare 
Technical Advisory Group Beneficiary Survey; Form No.: HCFA-R-178; Use: 
Survey will be used to evaluate the effectiveness of the ``Important 
Message From Medicare,'' which is used to inform beneficiaries of their 
rights. The survey will involve Peer Review Organizations, hospitals, 
and Medicare beneficiaries.; Frequency: One time; Respondents: 
Individuals or households, businesses or other for profit, nonprofit 
institutions; Estimated Number of Responses: 24,000; Average Hours Per 
Response: .25; Total Estimated Burden Hours: 6,030.
    2. Type of Request: New; Title of Information Collection: Estimated 
Acquisition Costs of Injectable Drugs; Form No.: HCFA-R-169; Use: This 
allows the Medicare carriers to more accurately set Medicare payment 
for the cost of covered drugs to Medicare beneficiaries; Frequency: 
Annually; Respondents: Businesses or other for profit, small businesses 
or organizations; Estimated Number of Responses: 7,650 (reporting), 51 
(recordkeeping); Average Hours Per Response: .167 (reporting), 55 
(recordkeeping); Total Estimated Burden Hours: 4,083.
    3. Type of Request: Extension; Title of Information Collection: 
Request for Reconsideration of Part A Health Insurance Benefits; Form 
No.: HCFA-2649; Use: This form is used to request reconsideration of an 
adverse determination made on Part A health insurance claims for items 
on services under the Medicare program; Frequency: On occasion; 
Respondents: Individuals or households, State or local governments; 
Estimated Number of Responses: 62,000; Average Hours Per Response: .25; 
Total Estimated Burden Hours: 15,500.
    4. Type of Request: Reinstatement; Title of Information Collection: 
Request for Hearing--Part B Medicare Claims; Form No.: HCFA-1965; Use: 
This form is used by either the Medicare claims beneficiary or a 
supplier/physician to request a hearing with the Medicare carriers 
hearing officer, once supplementary Medicare Insurance benefits have 
been denied at the informal review stage; Frequency: On occasion; 
Respondents: Individuals or households, small businesses or 
organizations; Estimated Number of Responses: 55,000; Average Hours Per 
Response: 10 minutes; Total Estimated Burden Hours: 9,166.
    5. Type of Request: New; Title of Information Collection: 
Examination and Treatment for Emergency Medical Conditions and Women in 
Labor; Form No.: HCFA-R-142; Use: Under Section 1867 of the Social 
Security Act, Examination and Treatment for Emergency Medical 
Conditions and Women in Labor, effective August 1, 1986, hospitals may 
continue to participate in Medicare only if they are not out of 
compliance with its provisions. We need these reports and information 
to promote uniform and thorough application of the requirements and to 
gather information frequently requested by Congress and other 
interested carriers regarding the 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: Unavailable; Average Hours 
Per Response: Unavailable; Total Estimated Burden Hours: 9,349,760.40.
    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: October 17, 1994.
Kathleen Larson,
Acting Director; Management Planning and Analysis Staff, Office of 
Financial and Human Resources, Health Care Financing Administration.
[FR Doc. 94-26770 Filed 10-27-94; 8:45 am]
BILLING CODE 4120-03-P