Public Information Collection Requirements Submitted to the Office of Management and Budget (OMB) for Clearance

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 (Pub. L. 96-511).

1. Type of Request: New Collection;

Title of Information Collection: Medicaid Drug Rebate--Remittance

Advice Report;

Form No.: HCFA-304;

Use: The Omnibus Budget Reconciliation Act of 1990 requires drug

manufacturers to enter into and have in effect a rebate agreement with

HCFA for States to receive funding for drugs dispensed to Medicaid

recipients. The regulations at 42 CFR 447.534 and 447.536 require

manufacturers to report specific drug rebate information to States when

payment is made;

Respondents: Business or other for profit;

Number of Respondents: 482;

Total Annual Responses: 1,928;

Total Annual Hours Requested: 116,896.

2. Type of Request: Reinstatement;

Title of Information Collection: Termination of Enrollment

Regulation--BPD-306;

Form No.: HCFA-141;

Use: The termination of enrollment requirement allows States,

through contracts with Federally Qualified Health Maintenance

Organizations (HMO) and certain other managed care contracts to

restrict disenrollment from an HMO up to a 6-month period. However,

Medicaid beneficiaries are allowed to disenroll during the period for

good cause;

Respondents: Business or other for profit, State or local

government;

Number of Respondents: 60,214;

Total Annual Responses: 1;

Total Annual Hours Requested: 15,054.

3. Type of Request: Reinstatement;

Title of Information Collection: Information Collection Requirement

at [[Page 14436]] 42 CFR 447.53(d) Imposition of Cost Sharing Charges

Under Medicaid (BERC-509);

Form No.: HCFA-R53;

Use: The information collection requirement at 42 CFR 447.53(d)

requires the States to include in their Medicaid State plan their

provisions for imposition of cost sharing on the medically and

categorically needy;

Respondents: State or local government;

Number of Respondents: 54;

Total Annual Responses: 54;

Total Annual Hours Requested: 2,700.

4. Type of Request: Reinstatement;

Title of Information Collection: Medicare Current Beneficiary

Survey--Community Component Supplement PR: ``Sources Of Information

About Medicare'';

Form No.: HCFA-P-0015A;

Use: This supplement is intended to find out from a systematic

sample of Medicare beneficiaries, how they obtain information about

program rules and procedures when they need it. It also elicits their

opinion of the adequacy of the information they found, and alternative

means by which HCFA might provide this information;

Respondents: Individuals and households;

Number of Respondents: 12,000;

Total Annual Responses: 12,000;

Total Annual Hours Requested: 2,000.

5. Type of Request: Reinstatement;

Title of Information Collection: Application for Hospital

Insurance;

Form No.: HCFA-18;

Use: This form is used to establish entitlement to Hospital

Insurance and Supplementary Medical Insurance for beneficiaries covered

under only title XVIII of the Social Security Act;

Respondents: Business or other for profit, Federal Government,

State or local government, farms, individuals and households;

Number of Respondents: 50,000;

Total Annual Responses: 50,000;

Total Annual Hours Requested: 12,500.

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, DC 20503.

Dated: March 7, 1995.

Kathleen B. Larson,

Director, Management Planning and Analysis Staff, Office of Financial

and Human Resources, Health Care Financing Administration.

[FR Doc. 95-6553 Filed 3-16-95; 8:45 am]

BILLING CODE 4120-03-P