[Federal Register Volume 62, Number 164 (Monday, August 25, 1997)]
[Notices]
[Pages 44976-44977]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-22451]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[Document Identifier: HCFA 1763, 2088 and R-142]


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

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 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: Request for Termination of 
Premium Hospital and/or Supplementary Medical Insurance and Supporting 
Regulations in 42 CFR 406.28 and 407.27; Form No.: HCFA-1763 (OMB No. 
0938-0025); Use: The HCFA-1763 is used by beneficiaries to request 
voluntary termination from premium hospital and/or supplementary 
medical insurance. Frequency: One time only; Affected Public: 
Individuals or Households and Federal Government; Number of 
Respondents: 14,000; Total Annual Responses: 14,000; Total Annual 
Hours: 5,833.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Outpatient 
Rehabilitation Cost Report and Supporting Regulations in 42 CFR 413.20 
and 413.24 Form No.: HCFA-2088 (OMB No. 0938-0037); Use: This form is 
used by Outpatient Rehabilitation Facilities to report their health 
care costs to determine the amount reimbursable for services furnished 
to Medicare beneficiaries. Frequency: Annually; Affected Public: 
Business or other for-profit, Not-for-profit institutions, and State, 
Local or Tribal Government; Number of Respondents: 4,298; Total Annual 
Responses: 4,298; Total Annual Hours: 429,800.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Information 
Collection Requirements Contained in BPD-393, Examination and Treatment 
for Emergency Medical Conditions and Women in Labor and Supporting 
Regulations Contained in 42 CFR 488.18, 489.20 and 489.24; Document 
No.: HCFA--R-142 (OMB# 0938-0667); Use: The Information Collection 
Requirements contained in BPD-393, Examination and Treatment for 
Emergency Medical Conditions and Women in Labor contains requirements 
for hospitals to prevent them from inappropriately transferring 
individuals with emergency medical conditions, as mandated by Congress. 
HCFA will use this information to help assure compliance with this 
mandate and protect the public. This information is not contained 
elsewhere in regulations. Frequency: On occasion; Affected Public: 
Individuals or Households, Not-for-profit institutions, Federal

[[Page 44977]]

Government, and State, Local or Tribal Government; Number of 
Respondents: 7,000; Total Annual Responses: 7,000; Total Annual Hours 
Requested: 1.
    It should be noted for the HCFA-R-142, OMB 0938-0667, that based on 
industry input and HCFA analysis, the applicability and burden 
associated with the information collection requirements (ICR) captured 
in this submission have been adjusted to properly reflect the degree of 
burden associated with this collection. In particular, the ICRs 
captured in this submission have been determined to be either exempt or 
the burden has been deemed usual and customary in accordance with the 
1995 PRA. In order to comply and properly reflect the Act, HCFA 
assigned a token one-hour of burden for this submission.
    To obtain copies of the supporting statement and any related forms 
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 30 days of this notice directly to 
the OMB desk officer: OMB Human Resources and Housing Branch, 
Attention: Allison Eydt, New Executive Office Building, Room 10235, 
Washington, D.C. 20503.

    Dated: August 18, 1997.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA Office of Information Services, 
Information Technology Investment Management Group, Division of HCFA 
Enterprise Standards.
[FR Doc. 97-22451 Filed 8-22-97; 8:45 am]
BILLING CODE 4120-03-P