[Federal Register Volume 64, Number 37 (Thursday, February 25, 1999)]
[Notices]
[Page 9336]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-4703]



[[Page 9336]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[Document Identifier: HCFA-287, HCFA-1491, HCFA-P-15A & HCFA-37]


Agency Information Collection Activities: Submission for OMB 
Review; 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, has 
submitted to the Office of Management and Budget (OMB) the following 
proposal for the collection of information. 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) Type of Information Collection Request: Extension of a 
currently approved collection;
    Title of Information Collection: Home Office Cost Statement and 
Supporting Regulations in 42 CFR Section 413.17;
    Form No.: HCFA-287 (OMB #0938-0202);
    Use: Medicare law permits components of chain organizations to be 
reimbursed for certain costs incurred by the Home Offices of the chain. 
The Home Office Cost Statement is required by the fiscal intermediary 
to verify Home Office Costs claimed by the components. This requires 
that the provider include in its costs, the costs incurred by the 
related organization in furnishing such services, supplies or 
facilities.
    Frequency: Annually.
    Affected Public: Not-for-profit institutions, Business or other 
for-profit.
    Number of Respondents: 1,231.
    Total Annual Responses: 1,231.
    Total Annual Hours: 573,646.
    (2) Type of Information Collection Request: Extension of a 
currently approved collection;
    Title of Information Collection: Request for Medicare Payment--
Ambulance and Supporting Regulations in 42 CFR Section 410.40 and 
424.124;
    Form No.: HCFA-1491 (OMB #0938-0042);
    Use: This form is used by physicians, suppliers, and beneficiaries 
to request payment of Part B Medicare services. It is used to apply for 
reimbursement for ambulance services.
    Frequency: On occasion;
    Affected Public: Business or other for-profit, Individuals or 
households, and Not-for-profit Institutions;
    Number of Respondents: 9,634,435;
    Total Annual Responses: 9,634,435;
    Total Annual Hours: 406.251.
    (3) Type of Information Collection Request: New Collection;
    Title of Information Collection: Medicare Information Needs: 
Supplement to the Medicare Current Beneficiary Survey (MCBS).
    Form No.: HCFA-P-15A (OMB# 0938-NEW);
    Use: This supplement to the MCBS builds upon the previously fielded 
Round 18 Supplement, which provided useful information to HCFA's Center 
for Beneficiary Services on beneficiary information needs and 
preferences for how to receive information. Results from this data 
collection will be used by HCFA to guide continued development of 
communication and education programs for Medicare beneficiaries.
    Affected Public: Individuals or Households;
    Number of Respondents: 12,000;
    Total Annual Responses: 12,000;
    Total Annual Hours: 3,000.
    (4) Type of Information Collection Request: Revision of a currently 
approved collection;
    Title of Information Collection: Medicaid Program Budget Reports 
and Supporting Regulations in 42 CFR Section 430.30;
    Form No.: HCFA-37 (OMB# 0938-0101);
    Use: The Medicaid Program Budget report is prepared by the State 
Medicaid Agencies and is used by HCFA for; (1) developing National 
Medicaid Budget estimates, (2) quantifying Budget Assumptions, (3) 
issuing quarterly Medicaid Grant Awards, and (4) collecting projected 
State receipts of donations and taxes;
    Frequency: Quarterly;
    Affected Public: State, Local or Tribal Government;
    Number of Respondents: 57;
    Total Annual Responses: 228;
    Total Annual Hours: 7,980.
    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 30 days of this notice directly to the OMB Desk Officer 
designated at the following address: OMB Human Resources and Housing 
Branch, Attention: Allison Eydt, New Executive Office Building, Room 
10235, Washington, D.C. 20503.

    Dated: February 22, 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. 99-4703 Filed 2-24-99; 8:45 am]
BILLING CODE 4120-03-P