[Federal Register Volume 61, Number 112 (Monday, June 10, 1996)]
[Notices]
[Pages 29406-29407]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-14479]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Health Care Financing Administration, HHS.

    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 summaries of proposed collections for public 
comment. Interested persons are invited to send comments regarding this 
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: End Stage Renal Disease 
(ESRD) Application and Survey and Certification Report Form; Form No.: 
HCFA-3427; Use: This form is a facility identification and screening 
measurement tool used to initiate the certification and recertification 
of ESRD facilities. The form is also completed by the Medicare/Medicaid 
State survey agency to determine facility compliance with ESRD 
conditions for coverage; Frequency: Annually; Affected Public: State, 
local or tribal governments; Number of Respondents: 2,640; Total Annual 
Hours: 2,376.
    2. Type of Information Collection Request: Reinstatement, without 
change, of previously approved collection for which approval has 
expired; Title of Information Collection: Withholding Medicare Payments 
to Recover Medicaid Overpayments; Form No.: HCFA-R-21; Use: Medicaid 
providers who have received overpayments may terminate or substantially 
reduce their participation in Medicaid to avoid the State's effort to 
recover the amounts due. This provision establishes a mechanism for 
State agencies to recoup the overpayments by withholding Medicare 
payments to these providers; Frequency: On occasion; Affected Public: 
State, local or tribal governments; Number of Respondents: 54; Total 
Annual Hours: 81.
    3. Type of Information Collection Request: Reinstatement, without 
change, of previously approved collection for which approval has 
expired; Title of Information Collection: Information Collection 
Requirements in HSQ-110, Acquisition, Protection and Disclosure of Peer 
Review Organization (PRO) Information--42 CFR 476.104, 476.105, 
476.116, and 476.134; Form No.: HCFA-R-70; Use: ``Medicare Disclosure 
Information, Regulatory'' The Peer Review Improvement Act of 1982 
authorizes PRO's to acquire information necessary to fulfill their 
duties and functions and places limits on disclosure of the 
information. These requirements are on the PRO to provide notices to 
the affected parties when disclosing information about them. These 
requirements serve to protect the rights of the affected parties; 
Frequency: On occasion; Affected Public: Business or other for profit; 
Number of Respondents: 53; Total Annual Hours: 30,577.
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Survey report 
Form (CLIA); 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.
    5. Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: Laboratory 
Personnel Report (CLIA); 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;

[[Page 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 P<a href="/cdn-cgi/l/email-protection#7d1c0d180f0a120f163d151e1b1c531a120b"><span class="__cf_email__" data-cfemail="1273627760657d6079527a7174733c757d64">[email protected]</span></a>, 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

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