[Federal Register Volume 71, Number 134 (Thursday, July 13, 2006)]
[Notices]
[Pages 39686-39687]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 06-6171]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Indian Health Service

AGENCY: Indian Health Service, HHS.

ACTION:  Request for public comment: 60-day proposed information 
collection: Indian Health Service Contract Health Service Report.

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SUMMARY: The Indian Health Service (IHS), as part of its continuing 
effort to reduce paperwork and respondent burden, conducts a pre-
clearance consultation program to provide the general public and 
Federal agencies with an opportunity to comment on proposed and/or 
continuing collections of information in accordance with the Paperwork 
Reduction Act of 1995 (PRA95) (44 U.S.C. 3506(c)(2)(A)). This program 
helps to ensure that requested data can be provided in the desired 
format, reporting burden (time and financial resources) is minimized, 
collection instruments are clearly understood, and the impact of 
collection requirements on respondents can be properly assessed. 
Currently, the IHS is providing a 60-day advance opportunity for public 
comment on a proposed new collection of information to be submitted to 
the Office of Management and Budget for review.
    Proposed Collection:
    Title: 0917-0002, `` Indian Health Service Contract Health Service 
Report''.
    Type of Information Collection Request: Extension, without 
revision, of currently approved information collection 0917-0002, 
``Indian Health Service Contract Health Service Report''.
    Form Number: IHS 843-1A.
    Need and Use of Information Collection: The purpose for the 
collection is to authorize contract health care providers to provide 
health care services to eligible IHS patients. The IHS form 843-1A 
``Order for Health Services'' was developed specifically for this 
collection of information. Other than revising the title ``Purchase-
Delivery Order for Health Services'' to read ``Order for Health 
Services'', acquisition terms on the front of the form, the contract 
clauses contained on the back of copy 3 of the form, the form has not 
been revised and there is no change in the substance or in the use of 
the form. A copy of the form is at Attachment 2.
    The majority of the information contained in this form is completed 
by IHS staff from existing IHS automated patient and vendor data files. 
Contract health care providers complete and sign the streamlined form 
and submit it, along with a completed standard Centers for Medicare & 
Medicaid Services (CMS) health claim form (CMS 1450 (UB 92) and CMS 
1500), to the IHS for verification and payment. The CMS forms are used 
and accepted nation-wide by the health care industry and IHS is an 
approved user.
    The information collection is needed to administer and manage the 
contract health care services provided to eligible American Indian and 
Alaska Native patients. The form is used to: Authorize contract health 
care services for eligible patients; certify that the health care 
services requested and authorized have been performed by the contract 
provider(s); process payments for health care services performed by 
such providers; obtain program data; and, serve as a legal document for 
health and medical care authorized by the IHS and rendered by health 
care providers under contract with the IHS.
    The information collected is also used for: Planning for further 
care of the patient; for keeping an accurate record of the patient's 
health status and health services received and recommended; for 
planning future health care programs; for communicating among members 
of the health care team; for evaluating the health care rendered; for 
research and continuing education; and, for the provision of program 
health statistics.
    Affected Public: Individuals and households.
    Type of Respondents: Individuals.
    Burden Hours: The table below provides the estimated burden hours 
for this information collection:

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                                                    Estimated
           Data collection instrument               number of     Responses per  Annual  number           Burden per  response *           Total annual
                                                   respondents     respondent     of  responses                                            burden hours
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IHS-843-1A.....................................           7,399              42         272,506  0.05 (3 mins)..........................        13,625.3
IDS * *........................................          13,717               1          13,717  0.05 (3 mins)..........................           685.8
                                                --------------------------------------------------------------------------------------------------------
    Total......................................          21,116  ..............  ..............  .......................................       14,311.1
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* For ease of understanding, burden hours are provided in actual minutes.
* * Inpatient Discharge Summary (IDS).

    There are no capital costs, operating costs and/or maintenance 
costs to respondents.
    Request for Comments: Your written comments and/or suggestions are 
invited on one or more of the following points: (a) Whether the 
information collection activity is necessary to carry out an agency 
function; (b) whether the agency processes the information collected in 
a useful and timely fashion; (c) the accuracy of public burden estimate 
(the estimated amount of time needed for individual respondents to 
provide the requested information); (d) whether the methodology and 
assumptions used to determine the estimate are logical; (e) ways to 
enhance the quality, utility and clarity of the information being 
collected; and (f) ways to minimize the public burden through the use 
of automated, electronic, mechanical, or other technological collection 
techniques or other forms of information technology.
    Send Comments and Requests for Further Information: For the 
proposed collection or requests to obtain a copy of the data collection 
instrument(s) and instructions to: Mrs. Christina Rouleau,

[[Page 39687]]

IHS Reports Clearance Officer, 801 Thompson Avenue, TMP, Suite 450, 
Rockville, MD 20852, call non-toll free (301) 443-5938, send via 
facsimile to (301) 443-2316, or send your e-mail requests, comments, 
and return address to: [email protected].
    Comment Due Date: Your comments regarding this information 
collection are best assured of having their full effect if received 
within 60 days of the date of this publication.

    Dated: July 6, 2006.
Charles W. Grim,
Assistant Surgeon General, Director, Indian Health Service.
[FR Doc. 06-6171 Filed 7-12-06; 8:45 am]
BILLING CODE 4165-16-M