[Federal Register Volume 64, Number 108 (Monday, June 7, 1999)]
[Notices]
[Pages 30340-30341]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-14319]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[Document Identifier: HCFA-1771]


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.
    Type of Information Collection Request: Extension of a currently 
approved collection;
    Title of Information Collection: Attending Physicians Statement and 
Documentation of Medicare Emergency and Supporting Regulations in 42 
CFR Sections 424.101 and 424.103;
    Form No.: HCFA-1771 (OMB# 0938-0023);
    Use: Payment, by Medicare, may be made for certain Part A inpatient 
hospital services and Part B outpatient services provided in a 
nonparticipating U.S. or foreign hospital, when services are necessary 
to prevent the death or serious impairment to the health of an 
individual. This form is used to document the attending physician's 
statement that the hospitalization was required due to an emergency and 
give clinical support for the claim;
    Frequency: On occasion;
    Affected Public: Business or other for profit;

[[Page 30341]]

    Number of Respondents: 2,000;
    Total Annual Responses: 2,000;
    Total Annual Hours: 500.
    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, DC 20503.

    Dated: May 19, 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. 99-14319 Filed 6-4-99; 8:45 am]
BILLING CODE 4120-03-P