[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]



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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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[FR Doc. 95-10754 Filed 5-1-95; 8:45 am]
BILLING CODE 4120-03-C