[Federal Register Volume 64, Number 27 (Wednesday, February 10, 1999)]
[Page 6664]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-3273]



Health Care Financing Administration
[Document Identifier: HCFA-R-243]

Agency Information Collection Activities: Proposed Collection; 
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, is 
publishing the following summary of proposed collections for public 
comment. 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.
    Type of Information Collection Request: New Collection; Title of 
Information Collection: Medicare Agreement Application, Health Care 
Prepayment Plan and Supporting Regulations in 42 CFR, Section 417; Form 
No.: HCFA-R-243; Use: An organization must meet certain requirements to 
be a Health Care Prepayment Plan that is eligible for a Medicare 1833 
agreement. The application is the collection form used to obtain 
information from an organization that would allow HCFA staff to 
determine compliance with the regulations. This form includes requests 
for information about: the management of the applicant organization; 
arrangements for providing health care to beneficiaries; meeting 
Medicare requirements for appeals, hearings, advance directives, health 
benefits; risk sharing with other entities; the fiscal soundness of the 
applicant; the cost budget, which forms the basis for HCFA payment; 
prevention of duplicate payment; and the applicant's marketing 
strategy. Frequency: Other (One time); Affected Public: Business or 
other for-profit institutions, Not-for-profit institutions, and State, 
Local or Tribal Governments.; Number of Respondents: 15; Total Annual 
Responses: 15; Total Annual Hours: 1,125.
    To obtain copies of the supporting statement for the proposed 
paperwork collections referenced above, or any related forms, E-mail 
your request, including your address and phone number, to 
Paperwork@hcfa.gov, or call the Reports Clearance Office on (410) 786-
1326. Written comments and recommendations for the proposed information 
collections must be mailed within 60 days of this notice directly to 
the HCFA Paperwork Clearance Officer designated at the following 
address: HCFA, Office of Information Services, Information Technology 
Investment Management Group, Division of HCFA Enterprise Standards, 
Attention: Dawn Willinghan, Room: N2-14-26, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850.

    Dated: February 1, 1999.
John P. Burke III,
HCFA Reports Clearance Officer, Division of HCFA Enterprise Standards, 
Health Care Financing Administration.
[FR Doc. 99-3273 Filed 2-9-99; 8:45 am]