[Federal Register Volume 61, Number 197 (Wednesday, October 9, 1996)]
[Notices]
[Page 52951]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-25833]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[HCFA-R-72]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
AGENCY: Health Care Financing Administration, HHS.
In compliance with the Paperwork Reduction Act of 1995 (44 U.S.C.
3501 et seq.), the Health Care Financing Administration (HCFA),
Department of Health and Human Services, has submitted to the Office of
Management and Budget (OMB) the following proposals 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: Reinstatement, without
change, of previously approved collection for which approval has
expired; Title of Information Collection: Information Collection
Requirements in 42 CFR 473.18 (a) and (b), 473.34 (a) and (b), 473.36
(a) and (b), and 473.42 (a), Peer Review Organization (PRO)
Reconsideration and Appeals ; Form No.: HCFA-R-72; Use: These
regulations contain procedures for PRO's to use in reconsideration of
initial determinations. The information requirements contained in these
regulations are on PROs to provide information to parties requesting a
reconsideration review. These parties will use the information as
guidelines for appeal rights in instances where issues are still in
dispute; Frequency: On occasion; Affected Public: Business or other for
profit; Number of Respondents: 53; Total Annual Responses: 15,670;
Total Annual Hours: 3,578.
2. Type of Information Collection Request: Reinstatement, without
change, of previously approved collection for which approval has
expired; Title of Information Collection: Request for Enrollment in
Supplementary Medical Insurance; Form No.: HCFA-4040; Use: The HCFA-
4040 is used to establish entitlement to Supplementary Medical
Insurance by Beneficiaries not eligible under Part A of Title XVIII or
Title II of the Social Security Act. The HCFA-4040SP is the Spanish
edition of this form; Frequency: One time only; Affected Public:
Individuals and households, Federal government, State, local, or tribal
governments; Number of Respondents: 10,000; Total Annual Responses:
10,000; Total Annual Hours: 2,500.
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Request for
Certification as a Rural Health Clinic, Rural Health Clinic Survey
Report Form; Form No.: HCFA-29, 30; Use: The form HCFA-29 ``Request for
Certification as a Rural Health Clinic'' is used by facilities to apply
to participate in the Medicare program. The form HCFA-30 ``Rural Health
Clinic Survey Report Form, is used by State survey agencies to record
data needed to determine compliance with the Federal requirements;
Frequency: Annually; Affected Public: State , local or tribal
governments; Number of Respondents: 390; Total Annual Responses: 390;
Total Annual Hours: 682.
4. Type of Information Collection Request: Reinstatement, without
change, of previously approved collection for which approval has
expired; Title of Information Collection: Quarterly Showing; Form No.:
HCFA-R-41; Use: This form is used by State Medicaid agencies to list
participating health care facilities and the dates the State agencies
reviewed the facilities. The lists are required to assure the existence
of an effective utilization (of services) control program, as required
by law and regulation, to avoid a penalty; Frequency: Quarterly;
Affected Public: State, local or tribal governments; Number of
Respondents: 47; Total Annual Responses: 188; Total Annual Hours:
9,212.
5. Type of Information Collection Request: Reinstatement, without
change, of previously approved collection for which approval has
expired; Title of Information Collection: Quarterly Showing Validation
Survey; Form No.: HCFA-9050; Use: Reporting entities may be required to
submit lists of Medicaid beneficiaries residing in a select number of
institutions. State Medicaid agencies may also be required to submit
procedures for conducting inspection of care reviews and other
documentation necessary to validate the Quarterly Showing reports. The
listings are required to determine those patients for which the State
is currently responsible for their care. This part of the operation to
determine that states have an effective utilization control program;
Frequency: Annually; Affected Public: State, local or tribal
governments; Number of Respondents: 47; Total Annual Responses: 8;
Total Annual Hours: 376.
6. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Business Proposal
Formats for Utilization and Quality Control Peer Review Organizations
(PROs); Form No.: HCFA-718-721; Use: Submission of proposal information
by current PROs and other bidders, according to the business proposal
instructions, will satisfy HCFA's need for consistent, and verifiable
data with which to validate contract proposals; Frequency: Other (Tri-
annually); Affected Public: Business or other for profit, not for
profit institutions; Number of Respondents: 20; Total Annual Responses:
23; Total Annual Hours: 450.
To obtain copies of the supporting statement and any related forms,
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 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: October 2, 1996.
Edwin J. Glatzel,
Director, Management Analysis and Planning Staff, Office of Financial
and Human Resources, Health Care Financing Administration.
[FR Doc. 96-25833 Filed 10-8-96; 8:45 am]
BILLING CODE 4120-03-P