[Federal Register Volume 61, Number 95 (Wednesday, May 15, 1996)]
[Notices]
[Pages 24501-24502]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-12104]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

AGENCY: Health Care Financing Administration.
    In compliance with the Paperwork Reduction Act of 1995 (44 U.S.C. 
3501 et seq.), the Health Care Financing

[[Page 24502]]

Administration (HCFA), Department of Health and Human Services, has 
submitted to the Office of Management and Budget (OMB) the following 
proposals for the collection of information. Interested persons are 
invited to send comments regarding the 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 
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 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 
10235, Washington, D.C. 20503.

    Dated: May 7, 1996.
Kathleen B. Larson,
Director, Management Planning and Analysis Staff, Office of Financial 
and Human Resources, Health Care Financing Administration.
[FR Doc. 96-12104 Filed 5-14-96; 8:45 am]
BILLING CODE 4120-03-P