[Federal Register Volume 63, Number 138 (Monday, July 20, 1998)]
[Notices]
[Pages 38838-38839]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-19256]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[Document Identifier: HCFA-21, 21B, 21P, 21.11A, 21E]


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

[[Page 38839]]

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.
    Type of Information Collection Request: New Collection;
    Title of Information Collection: Children's Health Insurance 
Program (CHIP) Budget and Expenditure System State Reporting Forms.
    Form Nos.: HCFA-21, 21B, 21P, 21.11A, 21E;
    Use: These forms will be used by State CHIP agencies to report CHIP 
program budget projections and actual CHIP program benefits and 
administrative expenditures, and the numbers of children being served 
in the CHIP program, to the Health Care Financing Administration 
(HCFA). The information provided by these new forms will be used by 
HCFA to prepare the grant awards to States for the CHIP, to ensure that 
the appropriate level of Federal payments for State expenditures under 
the CHIP are made in accordance with the CHIP-related BBA legislative 
provisions of 1997, and to track, monitor, and evaluate the numbers of 
children being served by the CHIP.
    Note: at this time Form HCFA-21E of this package is for States to 
report the numbers of children, by service delivery system, that are 
served in the States' CHIPs based on age categories. However, we are 
continuing to work with the States to develop an appropriate format for 
States to report the numbers of children, by service delivery system, 
that are served in the CHIP based on Federal poverty income level 
categories and under the age categories previously requested. When this 
format is finalized it will be incorporated into Form HCFA-21E.
    For a short description of the CHIP reporting forms, see below:
     Form HCFA-21 Summary Sheet. Quarterly Children's Health 
Insurance Program Statement of Expenditures for Title XXI Summary 
Sheet. This form summarizes the total expenditures in the State's CHIP 
reported by the State for the reporting quarter.
     Form HCFA-21. Children's Health Expenditures by Type of 
Service for the Title XXI Program, Expenditures in this Quarter. States 
use this form to report CHIP current quarter expenditures in accordance 
with services categories authorized under title XXI.
     Form HCFA-21B. Children's Health Insurance Program Budget 
Report for the Title XXI Program State Expenditure Plan. States use 
this form to report their budget projections each quarter for their 
Title XXI CHIPs for the current and budget Federal fiscal years and 
broken out by quarter.
     Form HCFA-21P. Children's Health Expenditures by Type of 
Service for the Title XXI Program, Prior Period Adjustments. States use 
this form to report CHIP prior period adjustment expenditures claimed 
in the submission quarter in accordance with services categories 
authorized under title XXI.
     Form HCFA-21.11A. Provider-Related Donations and Health 
Care Related Taxes, Fees, and Assessments Received Under Section 
1903(w) for Title XXI. States use this form to report CHIP-related 
State receipts of provider related donations, and health care related 
taxes, fees, and assessments.
     Form HCFA-21E. Children's Health Insurance Program, Number 
of Children Served. States use this form to report the numbers of 
children, by service delivery system, that are served in the States' 
CHIPs based on age categories.

    Note: HCFA is working with States to develop an appropriate 
format for States to report numbers of children, by service delivery 
system, that are served in the CHIP based on Federal poverty income 
level categories and under the age categories previously requested. 
When the format is finalized it will be incorporated into this form.

    Frequency: Quarterly;
    Affected Public: State and Federal government;
    Number of Respondents: 56;
    Total Annual Responses: 224;
    Total Annual Hours: 7,840.
    To obtain copies of the supporting statement 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 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 the HCFA Paperwork Clearance 
Officer designated at the following address: HCFA, Office of 
Information Services, Security and Standards Group, Division of HCFA 
Enterprise Standards, Attention: John Rudolph, Room C2-26-17, 7500 
Security Boulevard, Baltimore, Maryland 21244-1850.

    Dated: July 9, 1998.
John P. Burke III,
HCFA Reports Clearance Officer, Division of HCFA Enterprise Standards, 
Security and Standards Group, Health Care Financing Administration.
[FR Doc. 98-19256 Filed 7-17-98; 8:45 am]
BILLING CODE 4120-03-P