Proposals Submitted for Collection of Public Comment: Submission for OMB Review

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

Proposals Submitted for Collection of Public Comment: Submission

for OMB Review

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

proposals for the collection of information. 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. HCFA-R-107--Type of Request: Extension of a currently approved

collection; Title of Information Collection: Medicaid--Determining

Liability of Third Parties and supporting regulation 42 CFR 433.138;

Form No.: HCFA-R-0107; Use: The information collected from Medicaid

applicants and recipients as well as from State and local agencies is

necessary to determine the legal liability of third parties to pay for

medical services in lieu of Medicaid payment. Regulation 42 CFR

4333.138 requires the increase of third party resources to improve

program efficiencies and reduce Medicaid expenditures; Frequency: On

occasion; Affected Public: Federal Government and State, local, or

tribal government; Number of Respondents: Varies; Total Annual

Responses: Varies; Total Annual Hours: 171,165.

2. HCFA-R-188--Type of Information Collection Request: New

collection; Title of Information Collection: Federally Qualified Health

Center (FQHC) Survey; Form No.: HCFA-R-188; Use: This survey is needed

and will be used by HCFA to evaluate the FQHC Medicare benefit.

Respondents will be all Medicare certified FQHC's. Frequency: On

occasion; Affected Public: Not-for-profit institutions, and business or

other for-profit; Number of Respondents: 1,489; Total Annual Responses:

1,489; Total Annual Hours Requested: 496.

3. HCFA-R-193--Type of Information Collection Request: Existing

collection in use without an OMB control number; Title of Information

Collection: An Important Message from Medicare; Form No.: HCFA-R-193;

Use: Hospitals participating in the Medicare program have agreed to

distribute ``An Important Message from Medicare'' to beneficiaries

during each admission. Receiving this information will provide the

beneficiary with some ability to participate and/or initiate

discussions concerning decisions affecting Medicare coverage or payment

and about his or her appeal rights in response to any hospital's notice

to the effect that Medicare will no longer cover continued care in the

hospital. Recordkeeping: As needed; Affected Public: Individuals or

Households, Business or other for-profit; Not-for-profit institutions,

Federal Government, and State, Local or Tribal Government; Number of

Respondents: 6,700; Total Annual Responses: 11,000,000; Total Annual

Hours Requested: 183,333.

4. HCFA-R-194--Type of Information Collection Request: New

collection; Title of Information Collection: Medicare Disproportionate

Share

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Adjustment Procedure and Criteria; Form No.: HCFA-R-194; Use:

Regulation sets up an alternative process for hospitals that choose to

have their disproportionate share adjustment statistics calculated

based on their cost reporting periods rather than the Federal fiscal

year. Frequency: On occasion; Affected Public: Business or other for-

profit, and Not-for-profit institutions; Number of Respondents: 100;

Total Annual Responses: 100; Total Annual Hours Requested: 100.

5. HCFA-319--Type of Request: Reinstatement, without change, of a

previously approved collection for which approval has expired; Title of

Information Collection: State Medicaid Eligibility Quality Control

Sample Selection Lists; Form No.: HCFA-319; Use: The State MEQC

sampling list is necessary for regional offices to control and track

State MEQC reviews. The sample selection lists contain identifying

information on Medicaid beneficiaries. Frequency: Monthly; Affected

Public: State, local, or tribal government; Number of Respondents: 55;

Total Annual Hours: 5,280.

6. HCFA-856--Type of Information Collection Request: New

Collection; Title of Information Collection: National Payer Identifier

(PAYER-ID); Form No.: HCFA-856; Use: The PAYER-ID will allow payers of

health care claims to be identified by a unique numeric identifier.

PAYER-ID numbers will be assigned, but not limited to the following

groups: Medicare, Medicaid, VA, Public Health Service, large employers

and unions, HMOs, large insurers, etc.; Frequency: One time

(reporting); Affected Public: Not for profit institutions, business or

other for profit, Federal government, State, local or tribal

government; Number of Respondents: 85,000; Total Annual Responses:

85,000. Total Annual Hours: 85,000.

To request copies of the proposed paperwork collection referenced

above, E-mail your request, including your address, to

P[email protected], or call the Reports Clearance Office on (410) 786-

4193. 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: August 6, 1996.

Edwin J. Glatzel,

Director, Management Planning and Analysis Staff, Office of Financial

and Human Resources.

[FR Doc. 96-20668 Filed 8-13-96; 8:45 am]

BILLING CODE 4120-03-P