29406 Federal Register / Vol. 61, No. 112 / Monday, June 10, 1996 / Notices

NJDHS, NMHSD, NYDSS, NCDHR,

NDDHS, ODHS, PDPW, RIDHS, SCDSS,

SDDSS TDHS and the UDHS files with

the VA file and provide ADEC, CDSS,

CDHS, CDHR, DHSS, DCDHS, FDHRS,

GDHS, GDPHSS, HDHS, IDPA, KDSRS,

KDSI, LDSS, MDHR, MDTA, MDSS,

NDSS, NJDHS, NMHSD, NYDSS,

NCDHR, NDDHS, ODHS, PDPW, RIDHS,

SCDSS, SDDSS TDHS and the UDHS

with VA pension and compensation

benefit information. ADEC, CDSS,

CDHS, CDHR, DHSS, DCDHS, FDHRS,

GDHS, GDPHSS, HDHS, IDPA, KDSRS,

KDSI, LDSS, MDHR, MDTA, MDSS,

NDSS, NJDHS, NMHSD, NYDSS,

NCDHR, NDDHS, ODHS, PDPW, RIDHS,

SCDSS, SDDSS TDHS and the UDHS

will use the VA information to

determine the value of using VA

information to verify client

circumstances and to initiate adverse

action when appropriate.

C. Authority for Conducting the

Matching Program

ACF, HCFA, and FCS have an

obligation to assist State Public

Assistance Agencies in their efforts to

verify client circumstances when

determining an applicant’s eligibility for

public assistance benefits. The most

cost-effective and efficient way to verify

client declarations of income

circumstances is by means of a

computer match.

D. Categories of Records and

Individuals Covered by the Match

VA will disclose information from the

VA Compensation, Pension, and

Education and Rehabilitation Records—

VA (58 VA 21/22).

ACF will match this information with

ADEC, CDSS, CDHS, CDHR, DHSS,

DCDHS, FDHRS, GDHS, GDPHSS,

HDHS, IDPA, KDSRS, KDSI, LDSS,

MDHR, MDTA, MDSS, NDSS, NJDHS,

NMHSD, NYDSS, NCDHR, NDDHS,

ODHS, PDPW, RIDHS, SCDSS, SDDSS,

TDHS and the UDHS Client Eligibility

files.

E. Inclusive Dates of the Match

This computer match will begin no

sooner than 30 days from the date HHS

publishes a Computer Matching Notice

in the Federal Register or 30 days from

the date copies of the approved

agreement and the notice of the

matching program are sent to the

Congressional committee of jurisdiction

under subsections (0)(2)(B) and (r) of the

Privacy Act, as amended, or 30 days

from the date the approved agreement is

sent to the Office of Management and

Budget, whichever is later, provided no

comments are received which result in

a contrary determination.

F. Address for Receipt of Public

Comments or Inquiries

Individuals wishing to comment on

this matching program should submit

comments to the Director, Office of State

Systems, Administration for Children

and Families, Aerospace Building, 370

L’Enfant Promenade, SW., Washington,

DC 20047.

[FR Doc. 96–14556 Filed 6–7–96; 8:45 am]

BILLING CODE 4184–01–P

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.: HCFAR–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;
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.