[Federal Register Volume 61, Number 217 (Thursday, November 7, 1996)]
[Notices]
[Pages 57688-57689]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-28621]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[Document Identifier: HCFA-3427]
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: Survey Report Form (CLIA),
and supporting regulations 42 CFR 493.1 through 493.1804; Form No.:
HCFA-1557; Use: Clinical Laboratory Certification and Recertification:
This survey form is an instrument used by the State agency to record
data collected in order to determine compliance with CLIA; Frequency:
Biennially; Affected Public: Business or other for profit, not for
profit institutions, Federal government and State, local or tribal
governments; Number of Respondents: 30,225; Total Annual Hours: 16,322.
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Laboratory
Personnel Report (CLIA) and supporting regulations 42 CFR 493.1 through
493.1804; Form No.: HCFA-209; Use: This form is used by the State
agency to determine a laboratory's compliance with personnel
qualifications under CLIA. This information is needed for a
laboratory's CLIA certification and recertification; Frequency:
Biennially; Affected Public: Business or other for profit, not for
profit institutions, Federal, State, local or tribal governments;
Number of Respondents: 26,250; Total Annual Hours: 13,125.
3. Type of Information Collection Request: Revision of a currently
approved collection; Title of Information Collection: Medicare/Medicaid
Hospital Survey Report Form and supporting regulations 42 CFR 482.1
through 482.66; Form No.: HCFA-1537; Use: Section 1861(e) of the Social
Security Act provides that hospitals participating in Medicare must
meet specific requirements. These requirements are presented as
conditions of participation. State agencies must determine compliance
with these conditions through the use of this report form; Frequency:
Annually; Affected Public: State, local or tribal governments; Number
of Respondents: 1,322; Total Annual Hours Requested: 4,296.50.
4. Type of Information Collection Request: Reinstatement, with
change, of previously approved collection for which approval has
expired; Title of Information Collection: Medicare Managed Care
Disenrollment Form; Form No.: HCFA-566; Use: This form is used to
process a beneficiaries request of disenrollment action from a health
maintenance organization or competitive medical plan and to update the
beneficiaries' health insurance master record; Frequency: On occasion;
Affected Public: Individuals and households, business or other for
profit, not for profit institutions, Federal government, State, local,
or tribal governments; Number of Respondents: 24,000; Total Annual
Responses: 24,000; Total Annual Hours: 792.
5. Type of Information Collection Request: Reinstatement, without
change, of previously approved collection for which approval has
expired; Title of Information Collection: Ambulatory Surgical Center
(ASC) Request for Certification and Survey Report and Supporting
regulation 42 CFR 416; Form
[[Page 57689]]
No.: HCFA-377, HCFA-378; Use: The HCFA-377 is the application used by
an ASC wanting to participate in the Medicare program. The HCFA-378 is
the survey form used by State survey agencies to determine ASC
compliance with individual conditions of coverage. 42 CFR 416 is the
regulation supporting the data collected on the HCFA-377 and HCFA 378;
Frequency: Annually; Affected Public: State, local, or tribal
governments, business or other for profit, not-for-profit institutions;
Number of Respondents: 1,900; Total Annual Responses: 1,900; Total
Annual Hours: 475.
6. Type of Information Collection Request: Reinstatement, without
change, of previously approved collection for which approval has
expired; Title of Information Collection: Medigap Complaint Database
and Supporting Regulation 42 CFR 403.210 (b); Form No.: HCFA-R-156;
Use: The Medigap database is maintained by the National Association of
Insurance Commissioners, which in turn, sends the Medigap-relevant data
to HCFA. The information is used to monitor State handling of Medigap
related complaints; Frequency: Quarterly; Affected Public: Business or
other for-profit; Number of Respondents: 1; Total Annual Responses: 4;
Total Annual Hours: 160.
7. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Comprehensive
Outpatient Rehabilitation Facility (CORF) Eligibility and Survey Forms
and Information Collection Requirements in 42 CFR 485.56, 485.58,
485.60; Form No.: HCFA-359, HCFA-360, HCFA-R-55; Use: In order to
participate in the Medicare program as a CORF, providers must meet
Federal conditions of participation. The certification form is needed
to determine if providers meet at least preliminary requirements. The
survey form is used to record provider compliance with the individual
conditions and report findings to HCFA; Frequency: Annually; Affected
Public: Business or other for profit, not for profit institutions,
State, local, or tribal governments; Number of Respondents: 162; Total
Annual Responses: 324; Total Annual Hours: 526 (reporting), 77,014
(record keeping).
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 28, 1996
Edwin J. Glatzel,
Director, Management Analysis and Planning Staff, Office of Financial
and Human Resources, Health Care Financing Administration.
[FR Doc. 96-28621 Filed 11-6-96; 8:45 am]
BILLING CODE 4120-03-P