[Federal Register Volume 64, Number 7 (Tuesday, January 12, 1999)]
[Notices]
[Pages 1810-1811]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-669]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[Document Identifier: HCFA-0319, 0381, 1856/1893, and 1880/1882]


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: State Medicaid 
Eligibility Quality Control (MEQC) Sample Section Lists and Supporting 
Regulations in 42 CFR 431.800-431.865; Form No.: HCFA-0319 (OMB# 0938-
0147); Use: At the beginning of each month, State agencies are required 
to submit sample selection lists which identify all of the cases 
selected for review in the States' samples. These reviews are conducted 
to determine whether the sampled cases meet applicable State Title XIX 
eligibility requirements. The sample selection lists contain 
identifying information on Medicaid beneficiaries such as: State agency 
review number; beneficiary's name and address; the name of the county 
where beneficiary resides; and the Medicaid case number. The reviews 
are also used to assess beneficiary liability, if any, and to determine 
the amounts paid to provide Medicaid services for these cases.; 
Frequency: Monthly; Affected Public: State, Local or Tribal Government; 
Number of Respondents: 55; Total Annual Responses: 660; Total Annual 
Hours: 5,280.
    2. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Identification of 
Extension Units of Outpatient Physical Therapy (OPT) and Outpatient 
Speech Pathology (OSP) Providers and Supporting Regulations in 42 CFR 
485.701-785.729; Form No.: HCFA-381 (OMB# 0938-0273); Use: Medicare 
requires OPT/OSP providers to be surveyed to determine compliance with 
Federal requirements. When an OPT/OSP provider furnishes services to 
locations other than their already certified premises (extension 
locations), those premises are considered to be part of the OPT/OSP 
provider and are subject to the same Medicare regulations as the 
primary location. This form is used by the State survey agencies and by 
the HCFA regional offices to identify and monitor extension locations 
to ensure their compliance with Federal requirements. The HCFA-381 form 
requests information such as: facility name, provider number, where 
services are rendered, and the number of OPT/OSP services rendered.; 
Frequency: Annually; Affected Public: Business or other for-profit; 
Number of Respondents: 2,300; Total Annual Responses: 2,300; Total 
Annual Hours: 575.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Request for 
Certification in the Medicare and/ or Medicaid Program to Provide 
Outpatient Physical Therapy (OPT) and/or Speech Pathology Services, 
Outpatient Physical Therapy Speech Pathology Survey Report and 
Supporting Regulations in 42 CFR 485.701-485.729; Form No.: HCFA-1856/
1893 (OMB# 0938-0065); Use: The request for certification form is

[[Page 1811]]

used by State agency surveyors to determine if minimum Medicare 
eligibility requirements are being met by OPT providers. The survey 
report form records whether providers or suppliers are complying with 
HCFA health and safety requirements. The basic identifying information 
from this form is coded into the Online Survey Certification and 
Reporting System and serves as the information base for the creation of 
a record for future Federal certification and for monitoring activity.; 
Frequency: On occasion; Affected Public: Business or other for-profit; 
Number of Respondents: 1,700; Total Annual Responses: 1,700; Total 
Annual Hours: 446.
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Request for 
Certification as Supplier of Portable X-ray Services under the 
Medicare/Medicaid Program for Portable X-ray Survey Report and 
Supporting Regulations in 42 CFR 405.1411-405.1416 and 486.100-486.110; 
Form No.: HCFA-1880/1882 (OMB# 0938-0027); Use: The Medicare program 
requires portable X-ray suppliers to be surveyed for health and safety 
standards. The HCFA-1880 is used by the surveyor to determine if a 
portable X-ray applicant meets the eligibility requirements. It also 
promotes data reduction or introduction, and retrieval from the Online 
Survey Certification and Reporting (OSCAR) System by the HCFA Regional 
Offices. The HCFA-1882 is the survey form that records survey results. 
The form is primarily a coding work sheet designed to facilitate data 
reduction and retrieval into the OSCAR system at the HCFA Regional 
Offices. Frequency: On occasion; Affected Public: Business or other for 
profit; Number of Respondents: 520; Total Annual Responses: 520; Total 
Annual Hours: 137.
    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, Security and Standards Group, Division of HCFA 
Enterprise Standards, Attention: Louis Blank, Room N2-14-26, 7500 
Security Boulevard, Baltimore, Maryland 21244-1850.

    Dated: January 4, 1999.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA Office of Information Services, 
Security and Standards Group, Division of HCFA Enterprise Standards.
[FR Doc. 99-669 Filed 1-11-99; 8:45 am]
BILLING CODE 4120-03-P