[Federal Register Volume 61, Number 40 (Wednesday, February 28, 1996)]
[Notices]
[Page 7522]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-4534]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration


Public Information Collection Requirements Submitted for Public 
Comment and Recommendations

    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 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: Reinstatement, without 
change, of a previously approved collection for which approval has 
expired; Title of Information Collection: Medicare and Medicaid 
Disclosure of Ownership and Control Interest Statement; Form No.: HCFA-
1513; Use: The information provided on this form is used by State 
agencies and HCFA regional offices to determine whether providers meet 
the eligibility requirements for Titles 18 and 19 (Medicare and 
Medicaid) and for grants under Titles 5 and 20. Review of ownership and 
control is particularly necessary to prohibit ownership and control for 
individuals excluded under Federal Fraud statutes; Frequency: On 
Occasion; Affected Public: Business or other for profit, not-for-
profit; Number of Respondents: 60,000; Total Annual Hours: 30,000.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Evaluation of the 
Program of All-Inclusive Care for the Elderly (PACE) Demonstration; 
Form No.: HCFA-R-165; Use: This survey will collect data on functional 
status, service utility, and out-of-pocket costs, and satisfaction for 
a sample of applicants to the PACE program. This information will be to 
analyze the decision to participate in PACE and the impact of the 
program; Frequency: Semi-annually; Affected Public: Individuals and 
households; Number of Respondents: 1,833; Total Annual Hours: 3,745.
    To obtain copies of the supporting statement for the proposed 
paperwork collections referenced above, access HCFA's WEB SITE ADDRESS 
at http://www.ssa.gov/hcfa/hcfahp2.html , or to obtain the supporting 
statement and any related forms, E-mail your request, including your 
address and phone number, to P[email protected], or call the Reports 
Clearance Office on (410) 786-1326. Written comments and 
recommendations for the proposed information collections must be mailed 
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: February 16, 1996.
Kathleen B. Larson,
Director, Management Planning and Analysis Staff, Office of Financial 
and Human Resources, Health Care Financing Administration.
[FR Doc. 96-4534 Filed 2-27-96; 8:45 am]
BILLING CODE 4120-03-P