[Federal Register Volume 61, Number 79 (Tuesday, April 23, 1996)]
[Notices]
[Pages 17903-17904]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-9871]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Indian Health Service


Proposed Information Collection Activities Available for Public 
Comment and Recommendations

    In accordance with Section 3506(c)(2)(A) of the Paperwork Reduction 
Act of 1995, the Indian Health Service (IHS) is requesting public 
comment on the following proposed agency information collection 
activities. Your comments are invited on: (a) Whether the information 
collection activity is necessary to carry out an agency function and 
whether the IHS processes the information collected in a useful and 
timely fashion; (b) the accuracy of the public burden estimate (this is 
the amount of time needed for individual respondents to provide the 
requested information) and the methodology and assumptions used to 
determine the estimate; (c) ways to enhance the quality, utility, and 
clarity of the information being collected; and (d) ways to minimize 
the public burden through the use of automated, electronic, mechanical, 
or other technological collection techniques or other forms of 
information technology.
    Proposed Activity #1: The IHS Contract Health Service (CHS) seeks 
(A) approval for a 1 year reinstatement with no change of previously 
approved information collection activity, 0917-0002, ``Indian Health 
Service, Hospital, Dental and Other Contract Health Service Reports''; 
and (B) a 1 year approval for a new CHS form (IHS-843-1A, ``Purchase-
Delivery Order for Health Services'') which is currently being pilot 
tested and is expected to be completed by September 1996.
    The 1 year reinstatement of the current CHS forms and the 1 year 
approval of the new form will provide for a transition and 
implementation period for the new form and will allow the IHS to 
provide education and training in the use of the new single form; make 
any necessary adjustments in the protocol for the use of the new single 
form; and, make computer programming corrections as may be needed 
during the implementation period. The IHS-wide implementation of the 
new form is expected to be completed by the end of fiscal year 1997.
    The new streamlined, user friendly CHS form IHS-843-1A combines the 
three current CHS forms (the IHS 43-1A used for hospital inpatient 
services, the IHS-57-1A used for dental services, and, the IHS-64-1A 
used for health care services other than hospital inpatient or dental) 
into one single form which reduces public response burden. The CHS 
forms are completed by CHS Providers and used to certify that the 
health care services request and authorized by the IHS have been 
performed by the CHS provider(s); process payments for health care 
services performed by such providers; and serve as a legal document for 
health and medical care authorized by the IHS and rendered by health 
care providers under contract with the IHS. The burden estimate for 
this information collection activity follows:

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                                                             Responses                                          
       Information collection activity          Number of       per        Average burden per response (hours)* 
                                               respondents   respondent                                         
----------------------------------------------------------------------------------------------------------------
IHS-43-1A....................................          580          148  0.17 (10 mins).                        
IHS-57-1A....................................          532           22  0.42 (25 mins).                        
IHS-64-1A....................................        7,688           32  0.17 (10 mins).                        
New form: IHS-843-1A.........................       13.215           41  0.05 (3 mins).                         
Inpatient Discharge Summary..................       85,988            1  1.37 (82 mins).                        
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* Burden estimate is based on data provided by the IHS Fiscal Intermediary (FI) contractor and feedback from CHS
  Providers (respondents) who have completed the forms (current or new) for at least one year. For FY-1994, the 
  FI processed approximately 360,000 forms for some 8,800 respondents; and, the IHS CHS staff processed         
  approximately 180,000 forms for some 4,400 respondents. The number of responses per respondent is based on the
  average number of forms processed for each Provider.                                                          
The inpatient discharge summary was overlooked as an information collection activity in prior approval requests 
  and is added accordingly.                                                                                     

    Proposed Activity #2: The IHS Loan Repayment Program (LRP) seeks a 
3 year approval for reinstatement with minor change of previously 
approved information collection activity, 0917-0014, ``Indian Health 
Service Loan Repayment Program''. The IHS LRP recruits highly qualified 
health care professionals to meet agency health care staffing needs. 
The information collection forms used for this activity are contained 
in the IHS LRP Information and Application Booklet. The booklet 
provides an overview of the LRP, instructions regarding application 
procedures and potential employment opportunities, and tear-out 
application forms. The application form collects the following data 
from each applicant: Name, address, work and home telephone numbers, 
education and degree(s) obtained, work experience, and an accounting of 
financial (tuition) loans to be considered for payback. The 
instructions and forms contained in the LRP information and application 
booklet were updated, revised and clarified to improve applicant 
understanding and ease the response burden. The information collected 
is used to verify and evaluate applications to determine eligibility 
for the IHS LRP; award and authorize applicant payments; and, provide 
statistical program data. The burden estimate for this information 
collection activity follows:

[[Page 17904]]



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                                                             Responses                                          
       Information collection activity          Number of       per          Average burden/response (hours)*   
                                               respondents   respondent                                         
----------------------------------------------------------------------------------------------------------------
Section I....................................          350            1  0.25 (15 mins).                        
Section II...................................          350            1  0.50 (30 mins).                        
Section III..................................          350            4  0.25 (15 mins).                        
Contract.....................................          350            1  0.34 (20 mins).                        
Affidavit....................................          350            1  0.17 (10 mins).                        
Lender Cert..................................         1400            1  0.25 (15 mins).                        
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* Burden estimate is based on feedback from applicants or lenders who have completed these forms over the past  
  year.                                                                                                         

    To request more information on any of the proposed information 
collection activities or to obtain a copy of the collection of 
information form(s) and/or instructions, you may call the IHS Reports 
Clearance Officer on (301) 443-0461. This is not a toll free number. 
Please send your written comments regarding any or all of the proposed 
information collection activities to Mr. Lance Hodahkwen, Sr., IHS 
Reports Clearance Officer, 12300 Twinbrook Parkway, Suite 450, 
Rockville, MD 20857. Comments may also be sent via facsimile to: (301) 
443-1522, or Internet: L[email protected]. Written comments 
should be received within 60 days of this notice.

    Dated: April 16, 1996,
Michael H. Trujillo,
Assistant Surgeon General, Director.
[FR Doc. 96-9871 Filed 4-22-96; 8:45 am]
BILLING CODE 4160-16-M