Proposed Information Collection Activities Available for Public Comment and Recommendations

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Indian Health Service

Proposed Information Collection Activities Available for Public

Comment and Recommendations

In accordance with Section 3506(c)(2)(A) of the Paperwork Reduction

Act of 1995, the Indian Health Service (IHS) is requesting public

comment on the following proposed agency information collection

activities. Your comments are invited on: (a) Whether the information

collection activity is necessary to carry out an agency function and

whether the IHS processes the information collected in a useful and

timely fashion; (b) the accuracy of the public burden estimate (this is

the amount of time needed for individual respondents to provide the

requested information) and the methodology and assumptions used to

determine the estimate; (c) ways to enhance the quality, utility, and

clarity of the information being collected; and (d) ways to minimize

the public burden through the use of automated, electronic, mechanical,

or other technological collection techniques or other forms of

information technology.

Proposed Activity #1: The IHS Contract Health Service (CHS) seeks

(A) approval for a 1 year reinstatement with no change of previously

approved information collection activity, 0917-0002, ``Indian Health

Service, Hospital, Dental and Other Contract Health Service Reports'';

and (B) a 1 year approval for a new CHS form (IHS-843-1A, ``Purchase-

Delivery Order for Health Services'') which is currently being pilot

tested and is expected to be completed by September 1996.

The 1 year reinstatement of the current CHS forms and the 1 year

approval of the new form will provide for a transition and

implementation period for the new form and will allow the IHS to

provide education and training in the use of the new single form; make

any necessary adjustments in the protocol for the use of the new single

form; and, make computer programming corrections as may be needed

during the implementation period. The IHS-wide implementation of the

new form is expected to be completed by the end of fiscal year 1997.

The new streamlined, user friendly CHS form IHS-843-1A combines the

three current CHS forms (the IHS 43-1A used for hospital inpatient

services, the IHS-57-1A used for dental services, and, the IHS-64-1A

used for health care services other than hospital inpatient or dental)

into one single form which reduces public response burden. The CHS

forms are completed by CHS Providers and used to certify that the

health care services request and authorized by the IHS have been

performed by the CHS provider(s); process payments for health care

services performed by such providers; and serve as a legal document for

health and medical care authorized by the IHS and rendered by health

care providers under contract with the IHS. The burden estimate for

this information collection activity follows:

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Responses

Information collection activity Number of per Average burden per response (hours)*

respondents respondent

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IHS-43-1A.................................... 580 148 0.17 (10 mins).

IHS-57-1A.................................... 532 22 0.42 (25 mins).

IHS-64-1A.................................... 7,688 32 0.17 (10 mins).

New form: IHS-843-1A......................... 13.215 41 0.05 (3 mins).

Inpatient Discharge Summary.................. 85,988 1 1.37 (82 mins).

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* Burden estimate is based on data provided by the IHS Fiscal Intermediary (FI) contractor and feedback from CHS

Providers (respondents) who have completed the forms (current or new) for at least one year. For FY-1994, the

FI processed approximately 360,000 forms for some 8,800 respondents; and, the IHS CHS staff processed

approximately 180,000 forms for some 4,400 respondents. The number of responses per respondent is based on the

average number of forms processed for each Provider.

The inpatient discharge summary was overlooked as an information collection activity in prior approval requests

and is added accordingly.

Proposed Activity #2: The IHS Loan Repayment Program (LRP) seeks a

3 year approval for reinstatement with minor change of previously

approved information collection activity, 0917-0014, ``Indian Health

Service Loan Repayment Program''. The IHS LRP recruits highly qualified

health care professionals to meet agency health care staffing needs.

The information collection forms used for this activity are contained

in the IHS LRP Information and Application Booklet. The booklet

provides an overview of the LRP, instructions regarding application

procedures and potential employment opportunities, and tear-out

application forms. The application form collects the following data

from each applicant: Name, address, work and home telephone numbers,

education and degree(s) obtained, work experience, and an accounting of

financial (tuition) loans to be considered for payback. The

instructions and forms contained in the LRP information and application

booklet were updated, revised and clarified to improve applicant

understanding and ease the response burden. The information collected

is used to verify and evaluate applications to determine eligibility

for the IHS LRP; award and authorize applicant payments; and, provide

statistical program data. The burden estimate for this information

collection activity follows:

[[Page 17904]]

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Responses

Information collection activity Number of per Average burden/response (hours)*

respondents respondent

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Section I.................................... 350 1 0.25 (15 mins).

Section II................................... 350 1 0.50 (30 mins).

Section III.................................. 350 4 0.25 (15 mins).

Contract..................................... 350 1 0.34 (20 mins).

Affidavit.................................... 350 1 0.17 (10 mins).

Lender Cert.................................. 1400 1 0.25 (15 mins).

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* Burden estimate is based on feedback from applicants or lenders who have completed these forms over the past

year.

To request more information on any of the proposed information

collection activities or to obtain a copy of the collection of

information form(s) and/or instructions, you may call the IHS Reports

Clearance Officer on (301) 443-0461. This is not a toll free number.

Please send your written comments regarding any or all of the proposed

information collection activities to Mr. Lance Hodahkwen, Sr., IHS

Reports Clearance Officer, 12300 Twinbrook Parkway, Suite 450,

Rockville, MD 20857. Comments may also be sent via facsimile to: (301)

443-1522, or Internet: L[email protected]. Written comments

should be received within 60 days of this notice.

Dated: April 16, 1996,

Michael H. Trujillo,

Assistant Surgeon General, Director.

[FR Doc. 96-9871 Filed 4-22-96; 8:45 am]

BILLING CODE 4160-16-M