Federal Register / Vol. 60, No. 84 / Tuesday, May 2, 1995 / Notices 21525

Contact Person for More Information:

Nadine Dickerson, Program Analyst,

Radiation Studies Branch, Division of

Environmental Hazards and Health Effects,

National Center for Environmental Health,

Centers for Disease Control and Prevention,

4770 Buford Highway, NE, Mailstop F–35,

Atlanta, Georgia 30341–3724, telephone 404/

488–7040.

Dated: April 26, 1995.

John C. Burckhardt,

Acting Director, Management Analysis and

Services Office, Centers for Disease Control

and Prevention (CDC).

[FR Doc. 95–10827 Filed 4–28–95; 10:33 am]

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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 forprofit, 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 forprofit, 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.

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

BILLING CODE 4120–03–C