# Proposed Information Collection Activities Available for Public Comment and Recommendations > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/fr%3A96-9871 ## Record - **Collection:** Federal Register - **Document type:** Notice - **Published:** April 23, 1996 - **Citation:** 61 FR 17903 ## Text 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: ---------------------------------------------------------------------------------------------------------------- Responses Information collection activity Number of per Average burden per response (hours)* respondents respondent ---------------------------------------------------------------------------------------------------------------- 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). ---------------------------------------------------------------------------------------------------------------- * 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]] ---------------------------------------------------------------------------------------------------------------- Responses Information collection activity Number of per Average burden/response (hours)* respondents respondent ---------------------------------------------------------------------------------------------------------------- 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). ---------------------------------------------------------------------------------------------------------------- * 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 --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/fr%3A96-9871. Public record. Not legal advice.