[Federal Register Volume 60, Number 84 (Tuesday, May 2, 1995)] [Notices] [Pages 21525-21544] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 95-10754] ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Care Financing Administration Public Information Collection Requirements Submitted to the Office of Management and Budget (OMB) for Clearance AGENCY: Health Care Financing Administration, HHS. The Health Care Financing Administration (HCFA), Department of Health and Human Services, has submitted to OMB the following proposals for the collection of information in compliance with the Paperwork Reduction Act (Public Law 96-511). 1. Type of Request: Reinstatement; Title of Information Collection: Medicare Intermediary Request to Skilled Nursing Facilities for Medical Information on Claims to Be Processed; Form Nos.: NCFA-9031; Use: This information is used by the fiscal intermediaries to assure that reimbursement is made only for services that are covered under Medicare Part A or Part B for skilled nursing facilities. The medical information describes the patient's condition and level of medical needs and/or services provided. The records/information are submitted with claims or as requested; Respondents: Business or other for profit; Number of Respondents: 12,536; Total Annual Responses: 111,925; Total Annual Hours Requested: 55,963. 2. Type of Request: Revision; Title of Information Collection: Clinical Laboratory Improvement Amendments Budget Expenditure Report and Clinical Laboratory Improvement Amendments Planned Workload Report; Form No.: HCFA-102-105; Use: Information collected will be used by HCFA in determining the amount of Federal reimbursement for compliance surveys. Use of the information includes program evaluation, audit, budget formulation, and budget approval; Respondents: State, local, or tribal government; Number of Respondents: 53; Total Annual Responses: 2,650 (HCFA-102), 1,696 (quarterly); Total Annual Hours Requested: 4,346. 3. Type of Request: Reinstatement; Title of Information Collection: Medicare Home Health Quality Assurance Demonstration; Form No.: HCFA-P- 11; Use: The Medicare Home Health Quality Assurance Demonstration will test the feasibility of collecting patient outcome data in 50 Medicare- certified home health agencies (HHAs) nationally. Respondents will be HHA care providers and patients receiving their services; Respondents: Not-for-profit, businesses or other for-profit, and individuals or households; Number of Respondents: 27,844; Total Annual Responses: 111,376; Total Annual Hours Requested: 34,573. 4. Type of Request: Revision; Title of Information Collection: Medicare/Medicaid Health Insurance Common Claim Form and Instructions; Form No.: HCFA-1500; Use: This form will become a standardized form for use in the Medicare/Medicaid programs to apply for reimbursement for covered services. In addition, it will reduce costs and administrative burdens associated with claims since only one coding system will be used and maintained. HCFA does not require exclusive use of this form for Medicaid; Respondents: Not-for-profit, businesses or other for- profit, State, local or tribal government; Number of Respondents: 1; Total Annual Responses: 614,967,982; Total Annual Hours Requested: 52,139,385. 5. Type of Request: New (Expedited Review); Title of Information Collection: Study of the Cost of Administering Childhood Immunizations; Form No.: HCFA-R-175; Use: The proposed collection is to provide data of the resource costs for childhood immunization procedures to evaluate charge caps for physician practices participating in the recently enacted vaccines for children under the Medicaid program; Respondents: Business or other for profit; Number of Respondents: 100; Total Annual Responses: 100; Total Annual Hours Requested: 41. Additional Information or Comments: Call the Reports Clearance Office on (410) 966-5536 for copies of the clearance request packages. Written comments and recommendations for the proposed information collections should be sent 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: April 26, 1995. Kathleen B. Larson, Director, Management Planning and Analysis Staff, Office of Financial and Human Resources, Health Care Financing Administration. 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