[Federal Register Volume 60, Number 240 (Thursday, December 14, 1995)]
[Notices]
[Pages 64167-64168]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-30474]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Information Collection Requirements Submitted for Public 
Comment and Recommendations

AGENCY: Health Care Financing Administration, HHS.
    In compliance with the requirement of section 3506(c)(2)(A) of the 
Paperwork Reduction Act of 1995, the Health Care Financing 
Administration (HCFA), Department of Health and Human Services, is 
publishing the following summaries of proposed collections for public 
comment. Interested persons are invited to send comments regarding this 
burden estimate or any other aspect of this collection of information, 
including any 

[[Page 64168]]
of the following subjects: (1) The necessity and utility of the 
proposed information collection for the proper performance of the 
agency's functions; (2) the accuracy of the estimated burden; (3) ways 
to enhance the quality, utility, and clarity of the information to be 
collected; and (4) the use of automated collection techniques or other 
forms of information technology to minimize the information collection 
burden.
    1. Type of Information Collection Request: New collection; Title of 
Information Collection: Maximizing the Effectiveness of Home Health 
Care: The Influence of Service Volume and Integration With Other Care 
Settings on Patient Outcomes; Form No.: HCFA-R-189; Use: This study 
will examine (1) the relationship of home health care service volume 
and patient outcomes, and (2) the relationship of the physician role 
and integration of other services and patient outcomes; Frequency: 
Other (periodically); Affected Public: Not-for-profit institutions, 
business or other for profit, and individuals or households; Number of 
Respondents: 6,300; Total Annual Hours: 3,573.
    2. Type of Information Collection Request: Reinstatement, with 
change, of a previously approved collection for which approval has 
expired; Title of Information Collection: Request for Certification in 
the Medicare and/or Medicaid Program to Provide Outpatient Physical 
Therepy and/or Speech Pathology Services, Outpatient Physical Therapy 
Speech Pathology Survey Report; Form Nos.: HCFA-1856, HCFA-1893; Use: 
The Medicare Program requires outpatient physical therapy providers to 
meet certain health and safety requirements. The request for 
certification form is used by State agency surveyors to determine if 
minimum Medicare eligibility requirements are met. The survey report 
form records the result of the onsite survey; Frequency: On occasion; 
Affected Public: Business or other for profit; Number of Respondents: 
1,700; Total Annual Hours: 446.25.
    3. Type of Information Collection Request: Reinstatement, with 
change, of a previously approved collection for which approval has 
expired; Title of Information Collection: Request for Certification as 
Supplier of Portable X-ray Services Under the Medicare/Medicaid 
Programs, and Portable X-ray Survey Report; Form Nos.: HCFA-1880, HCFA-
1882; Use: The Medicare program requires portable x-ray suppliers to be 
surveyed for health and safety standards. The HCFA-1882 is the survey 
form that records survey results. The HCFA-1880 is used by the surveyor 
to determine if a portable x-ray applicant meets the eligibility 
requirements; Frequency: On occasion; Affected Public: Business or 
other for profit; Number of Respondents: 520; Total Annual Hours: 137.
    4. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Organ Procurement 
Organization's Request for Designation; Form No.: HCFA-576; Use: The 
information provided on this form serves as a basis for certifying 
organ procurement organizations (OPO) for participation in the Medicare 
and Medicaid programs and will indicate whether the OPO is meeting the 
specified performance standards for reimbursement of service; 
Frequency: Biennially; Affected Public: Business or other for profit, 
not-for-profit institutions; Number of Respondents: 80; Total Annual 
Hours: 160.
    5. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Physical 
Therapist in Independent Practice Request for Certification in the 
Medicare Program; Form No.: HCFA-262; Use: The HCFA-262 is used by the 
surveyors to determine if a physical therapist in independent practice 
requesting Medicare approval meets the eligibility requirements; 
Frequency: On occasion; Affected Public: Business or other for profit; 
Number of Respondents: 7,322; Total Annual Hours: 1,098.
    6. Type of Information Collection Request: Revision of a currently 
approved collection; Title of Information Collection: Request for 
Approval as a Hospital Provider of Extended Care Services (Swing-Bed) 
in the Medicare and Medicaid Programs; Form No.: HCFA-605; Use: The 
HCFA-605 is used for facility identification and screening. It will be 
completed by a hospital that is requesting approval and will initiate 
the process of determining the hospital's eligibility and for which bed 
count category the hospital wishes to request approval; Frequency: 
Other (one-time usage for initial application); Affected Public: 
Business or other for profit, not-for-profit institutions, Federal 
Government; Number of Respondents: 1,500; Total Annual Hours: 375.
    To request copies of the proposed paperwork collections referenced 
above, E-mail your request, including your address, to 
P[email protected], or call the Reports Clearance Office on (410) 786-
1326. Written comments and recommendations for the proposed information 
collections should be sent within 60 days of this notice directly to 
the HCFA Paperwork Clearance Officer designated at the following 
address: HCFA, Office of Financial and Human Resources, Management 
Planning and Analysis Staff, Attention: John Burke, Room C2-26-17, 7500 
Security Boulevard, Baltimore, Maryland 21244-1850.

    Dated: December 7, 1995.
Kathleen B. Larson,
Director, Management Planning and Analysis Staff, Office of Financial 
and Human Resources, Health Care Financing Administration.
[FR Doc. 95-30474 Filed 12-13-95; 8:45 am]
BILLING CODE 4120-03-P