[Federal Register Volume 62, Number 17 (Monday, January 27, 1997)]
[Notices]
[Pages 3902-3903]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-1917]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[Document Identifier: HCFA-643]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

    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 summary of proposed collections for public 
comment. 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. HCFA-643 Type of Information Collection Request: Reinstatement, 
without change, of previously approved collection for which approval 
has expired; Title of Information Collection: Hospice Survey and 
Deficiencies Report Form and Supporting Regulations 42 CFR Sections 
488,488.26(c), 442.30(a)(4), 442, Subpart B,C,D,E and F; Form No.: HCFA 
643; Use:. The survey report form and supporting regulations are needed 
to ensure provider compliance. In order to participate in the Medicare 
program, a hospice must meet certain Federal health and safety 
conditions of participation. The survey report form will be used by 
State surveyors to record data about a hospice's compliance with these 
conditions of participation in order to initiate the certification or 
recertification process. Frequency: Annually; Affected Public: State, 
Local or Tribal Govt, Federal Govt; Number of Respondents: 2,150; Total 
Annual Responses: 2,150; Total Annual Hours: 5,375.
    To obtain copies of the supporting statement for the proposed 
paperwork collections referenced above, 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

[[Page 3903]]

the HCFA Paperwork Clearance Officer designated at the following 
address: HCFA, Office of Financial and Human Resources, Management 
Analysis and Planning Staff, Attention: John Rudolph, Room C2-25-05, 
7500 Security Boulevard, Baltimore, Maryland 21244-1850.

    Dated: January 15, 1997.
Edwin J. Glatzel,
Director, Management Analysis and Planning Staff, Office of Financial 
and Human Resources.
[FR Doc. 97-1917 Filed 1-24-97; 8:45 am]
BILLING CODE 4120-03-P