[Federal Register Volume 60, Number 138 (Wednesday, July 19, 1995)]
[Notices]
[Pages 37066-37067]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-17658]



=======================================================================
-----------------------------------------------------------------------

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 (Public Law 96-511).
    1. Type of Request: Extension; Title of Information Collection: 
Statistical Report on Medical Care: Eligibles, Recipients, Payments & 
Services; Form No.: HCFA-2082; Use: The data reported in the HCFA-2082 
are the basis of actuarial forecasts for Medicaid services utilization 
and cost; of analyses and cost savings estimates required for 
legislative initiatives relating to Medicaid and HHS, the press, and 
the Congress. Frequency: Quarterly; Respondents: State, local, or 
tribal government; Number of Respondents: 54; Total Annual Responses: 
21,937.
    2. Type of Request: Reinstatement with change; Title of Information 
Collection: Internal Revenue Service (IRS)/Social Security 
Administration (SSA)/HCFA Data; Form No.: HCFA-R-137; Use: Employers 
identified through a match of IRS, SSA, and Medicare records will be 
contacted concerning group health plan coverage of identified 
individual to ensure compliance with Medicare Secondary Payer 
provisions found at 42 USC 1395y(b). Frequency: Annually; Respondents: 
Business or other for profit institutions, not-for-profit institutions, 
farms, Federal Government, State, local, or tribal government; Number 
of Respondents: 581,452; Total Annual Responses: 2,207,801.
    3. Type of Request: Reinstatement with change; Title of Information 
Collection: Conditions of Coverage for Portable X-Ray Suppliers; Form 
No.: HCFA-R-43; Use: This information is needed to determine if 
portable X-ray suppliers are in compliance with published health and 
safety requirements; Frequency: Annually; Respondents: Business or 
other for profit; Number of Respondents: 550; Total Annual Responses: 
1,375.
    4. Type of Request: New collection; Title of Collection: Evaluation 
of Intermediate Care Facilities for Persons with Mental Retardation; 
Form No.: HCFA-R-176; Use: The purpose of the project is to establish a 
baseline of current psychoactive drug usage of beneficiaries in 
Intermediate Care Facilities for Persons with Mental Retardation (ICFs/
MR). Data will be collected on approximately 2,040 beneficiaries using 
the Medical Administration Record. There will be no attempt to evaluate 
whether the drug usage is appropriate. Information 

[[Page 37067]]
regarding the characteristics of ICRs/MR will be gathered from 480 
facilities; Frequency: Annually; Respondents: Individuals and 
households, not-for-profit institutions, Federal Government, State, 
local, or tribal government; Number of Respondents: 2,520; Total Annual 
Responses: 2,520.
    Additional Information or Comments: Call the Reports Clearance 
Office on (410) 786-1326 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: July 10, 1995.
Kathleen B. Larson,
Director, Management Planning and Analysis Staff, Office of Financial 
and Human Resources, Health Care Financing Administration.
[FR Doc. 95-17658 Filed 7-18-95; 8:45 am]
BILLING CODE 4120-03-P