[Federal Register Volume 64, Number 57 (Thursday, March 25, 1999)]
[Notices]
[Pages 14454-14455]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-7291]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[HCFA-0319, 2786, and R-0074]


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 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

[[Page 14455]]

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: Fire Safety 
Survey Report Forms and Supporting Regulations in 42 CFR 416.44, 
418.100, 482.41, 483.70, 483.470; Form No.: HCFA-2786 A-D, F, G, H, J, 
K, L, M, P and Q (OMB# 0938-0242); Use: The information from these 
forms will be used to make Medicare/Medicaid certification decisions. 
We request information in accordance with the Life Safety Code of the 
National Fire Protection Association. HCFA then surveys all facilities 
based upon prior compliance history; that is, the ``good'' facilities 
will be surveyed less frequently. Either the short or long fire safety 
form will be utilized each time a health survey is performed, depending 
on the circumstances.; Frequency: Annually; Affected Public: State, 
Local, or Tribal Government; Number of Respondents: 53; Total Annual 
Responses: 30,000; Total Annual Hours: 25,000.
    3. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Income and 
Eligibility Verification System (IEVS) and Supporting Regulations in 42 
CFR 431.17, 431.306, 435.910, 435.920, 435.940-435.960; Form No.: HCFA-
R-0074 (OMB# 0938-0467); Use: Section 1137 of the Social Security Act 
requires Medicaid State agencies and other federally funded welfare 
agencies to request income and resource data from certain federal 
agencies, State wage information collection agencies, and State 
unemployment compensation agencies through an IEVS. The purpose of the 
IEVS is to ensure that only eligible individuals receive benefits.; 
Frequency: Annually; Affected Public: Individuals or Households, and 
State, Local, or Tribal government; Number of Respondents: 54; Total 
Annual Responses: 54; Total Annual Hours: 101,414.
    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 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: March 15, 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. 99-7291 Filed 3-24-99; 8:45 am]
BILLING CODE 4120-03-P