Federal Register / Vol. 61, No. 112 / Monday, June 10, 1996 / Notices 29407

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.

6. Type of Information Collection

Request: Reinstatement, without change,

of previously approved collection for

which approval has expired; Title of

Information Collection: Prepaid Health

Plan Cost Report; Form No.: HCFA–276;

Use: These forms are needed to establish

the reasonable cost providing covered

services to the enrolled Medicare

population of an HMO in accordance

with Section 1876 of the Social Security

Act; Frequency: Quarterly, Annually;

Affected Public: Business or other for

profit; Number of Respondents: 82;

Total Annual Hours: 9,934.

7. Type of Information Collection

Request: Reinstatement, without change,

of previously approved collection for

which approval has expired; Title of

Information Collection: Medicare Credit

Balance Reporting Requirements; Form

No.: HCFA–838; Use: The collection of

credit balance information is needed to

ensure that millions of dollars in

improper program payments are

collected. Approximately 37,600 health

care providers will be required to

submit a quarterly credit balance report

that indicates the amount of improper

payments they received that are due to

Medicare. The intermediaries will

monitor the reports to ensure these

funds are collected; Frequency:

Quarterly; Affected Public: Not for profit

institutions; Number of Respondents:

37,600; Total Annual Hours: 902,400.

8. Type of Information Collection

Request: Revision of a currently

approved collection; Title of

Information Collection: Statement of

Deficiencies and Plan of Correction;

Form No.: HCFA–2567–A; Use: This

Paperwork package provides

information regarding deficiencies for

Organ Procurement Organizations

(OPO) as well as deficiencies noted

during periodic facility and laboratory

certification surveys. This information

is used to make decisions concerning

OPO redesignation, certification/

recertification of health care facilities

participating in the Medicare/Medicaid

Programs, and laboratories regulated by

CLIA. Frequency: Annually and

Biennially; Affected Public: State, Local

or Tribal Governments, Business or

other for-profit, Not-for-profit

institutions, Federal Government;

Number of Respondents: 49,200; Total

Annual Responses: 98,400; Total

Annual Hours Requested: 196,800.

9. Type of Information Collection

Request: Revision of a currently

approved collection; Title of

Information Collection: Medicare/

Medicaid Hospital Survey Report Form;

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.

To obtain copies of the supporting

statement for the proposed paperwork

collections referenced above, access

HCFA’s WEB SITE ADDRESS at http://

www.hcfa.gov, or to obtain the

supporting statement and 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 Financial and Human

Resources, Management Planning and

Analysis Staff, Attention: John Burke,

Room C2–26–17, 7500 Security

Boulevard, Baltimore, Maryland 21244–

1850.

Dated: June 3, 1996.

Kathleen B. Larson,

Director, Management Planning and Analysis

Staff, Office of Financial and Human

Resources, Health Care Financing

Administration.

[FR Doc. 96–14479 Filed 6–7–96; 8:45 am]

BILLING CODE 4120–03–P

[R–10, R–79]

Agency Information Collection

Activities: Submission for OMB

Review; 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, has submitted to the

Office of Management and Budget

(OMB) the following proposal 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: Extension of a currently

approved collection; Title of

Information Collection: Information

Collection Requirements contained in

BPD–718: Advance Directives (Medicare

and Medicaid); Form No.: HCFA–R–10;

Use: Certain Medicare and Medicaid

organizations are responsible for

collecting and documenting, in medical

records, whether or not an individual

has executed an advance directive. This

document indicates the individual’s

preference if he/she is incapacitated.

Frequency: On occasion; Affected

Public: Business or other for-profit, Notfor-profit institutions, Federal

Government, and State, Local or Tribal

Government; Number of Respondents:

38,927; Total Annual Responses:

38,927; Total Annual Hours Requested:

908,250.

2. Type of Information Collection

Request: Reinstatement, with change, of

a previously approved collection for

which approval has expired; Title of

Information Collection: Payment

Adjustment for Sole Community

Hospitals; Form No.: HCFA–R–79; Use:

Hospitals designated as ‘‘Sole

Community Hospitals’’ that experience

a five percent decrease in discharges in

one cost reporting period, as compared

to the previous period, due to unusual

circumstances, beyond its control, may

request an adjustment to its Medicare

payment amount. Frequency: As

desired; Affected Public: Business or

other for-profit, Not-for-profit

institutions, and State, Local or Tribal

Government; Number of Respondents:

40; Total Annual Responses: 40; Total

Annual Hours Requested: 160.

To request copies of the proposed

paperwork collections referenced above,

E-mail your request, including your

address, to Paperwork@hcfa.gov, 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.
29408 Federal Register / Vol. 61, No. 112 / Monday, June 10, 1996 / Notices

Dated: June 3, 1996.

Kathleen B. Larson,

Director, Management Planning and Analysis

Staff, Office of Financial and Human

Resources, Health Care Financing

Administration.

[FR Doc. 96–14478 Filed 6–7–96; 8:45 am]

BILLING CODE 4120–03–P

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, with change, of

a previously approved collection for

which approval has expired; Title of

Information Collection: Physical

Therapist in Independent Practice

Survey Report; Form No.: HCFA–3042;

Use: The Medicare Program requires

physical therapists in an independent

practice to meet certain health and

safety requirements. The survey report

records the results of an onsite survey

to confirm that the health and safety

requirements are met; Frequency: On

occasion; Affected Public: Business or

other for profit; Number of Respondents:

2,196; Total Annual Hours: 2,196.

2. Type of Information Collection

Request: Reinstatement, without change,

of a previously approved collection for

which approval has expired; Title of

Information Collection: Health

Maintenance Organization (HMO) and

Competitive Medical Plan (CMP)

National Data Reporting Requirements

(NDRR); Form No.: HCFA–906; Use: The

NDRR provides the Office of Managed

Care staff with information required to

effectively monitor and evaluate the

progress and effectiveness of the HMO/

CMPs as appropriate. This ensures the

protection of Federal investment and

enrolled members of HMO/CMPs.

Additionally, the NDRR provides

statistical data for continued regulation;

Frequency: Quarterly, annually;

Affected Public: Business or other for

profit, not for profit institutions, and

state, local or tribal governments;

Number of Respondents: 292; Total

Annual Hours: 2,920.

3. Type of Information Collection

Request: Reinstatement, without change,

of a previously approved collection for

which approval has expired; Title of

Information Collection: Identification of

Extension Units of Outpatient Physical

Therapy and Outpatient Speech

Pathology Providers; Form No.: HCFA–

381; Use: The Medicare Program

requires outpatient physical therapy and

outpatient speech pathology (OPT/OSP)

providers to be surveyed to determine

compliance with Federal requirements.

The HCFA–381 is the form used to

identify OPT/OSP locations; Frequency:

Annually; Affected Public: Business or

other for profit; Number of Respondents:

2,300; Total Annual Hours: 575.

4. Type of Information Collection

Request: Reinstatement, without change,

of a previously approved collection for

which approval has expired; Title of

Information Collection: Fire Safety

Survey Report; Form No.: HCFA–2786

A,B,C,D,F,G,H,J,K,L,M,P,Q; Use: These

forms are used by the State Agency to

record data collected in order to

determine compliance with individual

conditions during fire safety surveys

and report it to the Federal Government;

Frequency: Annually; Affected Public:

State, local or tribal governments;

Number of Respondents: 53; Total

Annual Hours: 20,637.

To request copies of the proposed

paperwork collections referenced above,

E-mail your request, including your

address, to Paperwork@hcfa.gov, 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: June 3, 1996.

Kathleen B. Larson,

Director, Management Planning and Analysis

Staff, Office of Financial and Human

Resources, Health Care Financing

Administration.

[FR Doc. 96–14480 Filed 6–7–96; 8:45 am]

BILLING CODE 4120–03–P

Health Resources and Services

Administration

Availability of Funds for the Nursing

Education Loan Repayment Program

for Service in Certain Health Facilities

AGENCY: Health Resources and Services

Administration

ACTION: Notice of available funds.

SUMMARY: The Health Resources and

Services Administration (HRSA)

announces that applications will be

accepted for fiscal year (FY) 1996 for

awards under Section 846 of the Public

Health Service (PHS) Act to repay up to

85 percent of the nursing education

loans of registered nurses who agree to

serve for not less than 2 years as nurse

employees in certain health facilities.

The HRSA, through this notice,

invites applications for participation in

this loan repayment program.

Approximately $1,942,000 will be

available, and with these funds, the

HRSA estimates that approximately 179

loan repayment awards may be made.

The PHS is committed to achieving

the health promotion and disease

prevention objectives of Healthy People

2000, a PHS-led national activity for

setting health priorities. These programs

will contribute to the Healthy People

2000 objectives by improving access to

primary health care services through

coordinated systems of care for

medically underserved populations in

both rural and urban areas. Potential

applicants may obtain a copy of Healthy

People 2000 (Full Report, Stock No.

017–001–00474–01) or Healthy People

2000 (Summary Report, Stock No. 017–

001–00473–01) through the

Superintendent of Documents,

Government Printing Office,

Washington, D.C. 20402–9325

(telephone number: 202 783–3238).

The PHS strongly encourages all grant

and contract recipients to provide a

smoke-free workplace and promote the

non-use of all tobacco products. In

addition, Public Law 103–227, the ProChildren Act of 1994, prohibits smoking

in certain facilities (or in some cases,

any portion of a facility) in which

regular or routine education, library,

day care, health care, or early childhood

development services are provided to

children. This is consistent with the