[Federal Register Volume 63, Number 49 (Friday, March 13, 1998)]
[Notices]
[Page 12474]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-6453]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[Document Identifier: HCFA-417 and HCFA-724]


Agency Information Collection Activities: Proposed Collection; 
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 summary 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: Extension of a currently 
approved collection; Title of Information Collection: Hospice Request 
for Certification in the Medicare Program; Form No.: HCFA-417 (OMB# 
0938-0313); Use: The Hospice Request for Certification Form is used for 
hospice identification, screening, and to initiate the certification 
process. The information captured on this form is entered into a data 
base which assists HCFA in determining whether providers have 
sufficient personnel to participate in the Medicare program. The form 
summarizes data relative to: type of hospice; types of services 
provided by the hospice; and number of full time equivalents; 
Frequency: Annually; Affected Public: Business or other for-profit, 
Not-for-profit institutions, Federal Government, and State, local or 
tribal government; Number of Respondents: 2,286; Total Annual 
Responses: 2,286; Total Annual Hours: 572.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Medicare/Medicaid 
Psychiatric Hospital Survey Data and Supporting Regulations Contained 
in 42 CFR 482.60, 482.61 and 482.62; Form No.: HCFA-724 (OMB# 0938-
0378); Use: The Medicare/Medicaid Psychiatric Hospital Survey Data Form 
is used for hospital identification, and program planning and 
evaluation. The information captured on this form is entered into a 
data base which assists HCFA in maintaining accurate information on all 
free-standing psychiatric hospitals participating in the Medicare 
program. The form summarizes data relative to: hospital 
characteristics; types of services provided by the hospital; and 
hospital statistics; Frequency: Annually; Affected Public: Federal 
government, Business or other for-profit, Not-for-profit institutions, 
and State, local or tribal government; Number of Respondents: 350; 
Total Annual Responses: 350; Total Annual Hours: 175.
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access HCFA's 
Web Site address at http://www.hcfa.gov/regs/prdact95.htm, or E-mail 
your request, including your address, phone number, OMB number, and 
HCFA document identifier, 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 
Information Services, Information Technology Investment Management 
Group, Division of HCFA Enterprise Standards, Attention: Louis Blank, 
Room C2-26-17, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

    Dated: March 5, 1998.
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. 98-6453 Filed 3-12-98; 8:45 am]
BILLING CODE 4120-03-U