[Federal Register Volume 65, Number 234 (Tuesday, December 5, 2000)]
[Notices]
[Page 75943]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-30840]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[Document Identifier: HCFA-1491, HCFA-382, and HCFA-R-207]


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: 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: 9,301,183;
    Total Annual Responses: 9,301,183;
    Total Annual Hours: 390,418.
    (2.)Type of Information Collection Request: Extension of a 
currently approved collection;
    Title of Information Collection: ESRD Beneficiary Selection and 
Supporting Regulations Contained in 42 CFR 414.330;
    Form No.: HCFA-382 (OMB# 0938-0372);
    Use: ESRD facilities have each new home dialysis patient select one 
of two methods to handle Medicare reimbursement. The intermediaries pay 
for the beneficiaries selecting Method I and the carriers pay for the 
beneficiaries selecting Method II. This system was developed to avoid 
duplicate billing by both intermediaries and carriers.
    Frequency: Other (One time only);
    Affected Public: Individuals or households, business or other for-
profit, and not-for-profit institutions;
    Number of Respondents: 8,600;
    Total Annual Responses: 8,600;
    Total Annual Hours: 717.
    (3.) Type of Information Collection Request: Revision of a 
currently approved collection;
    Title of Information Collection: Evaluation of the State Medicaid 
Reform Demonstrations and Evaluation of the Medicaid Health Reform 
Demonstrations;
    Form No.: HCFA-R-207 (OMB# 0938-0708);
    Use: These evaluations investigate health care reform in ten states 
that have implemented demonstration programs using Section 1115 
waivers. The surveys gather information to answer questions regarding 
access to health care, quality of care delivered, satisfaction with 
health services, and the use and cost of health services. During the 
extended period of authorization, the surveys will be administered to 
Medicaid eligibles, both demonstration participants and comparison 
group non-participants.;
    Frequency: Other: One-time;
    Affected Public: Individuals or Households;
    Number of Respondents: 5,050;
    Total Annual Responses: 5,050;
    Total Annual Hours: 2,746.
    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 [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: November 20, 2000.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA, Office of Information Services, 
Security and Standards Group, Division of HCFA Enterprise Standards.
[FR Doc. 00-30840 Filed 12-4-00; 8:45 am]
BILLING CODE 4120-03-P