Agency Information Collection Activities: Proposed Collection; Comment Request

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[Document Identifier: HCFA-485 and HCFA-1513]

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: Extension of a currently

approved collection; Title of Information Collection: Home Health

Services Under Hospital Insurance and Supporting Regulations in 42 CFR

409.40-.50, 410.36, 410.170, 411.4-.15, 421.100, 424.22, 484.18 and

489.21; Form No.: HCFA-485 (OMB# 0938-0357); Use: The ``Home Health

Services Under Hospital Insurance'' is a certification and plan of care

used by the Regional Home Health Intermediaries (RHHIs) to ensure

reimbursement is made to Home Health agencies only for services that

are covered and medically necessary under Part A and Part B. The

attending physician must sign the HCFA-485 (OMB 0938-0357) authorizing

the home services for a period not to exceed 62 days; Frequency: Other

(initial claim and every second claim thereafter); Affected Public:

Business or other for-profit; Number of Respondents: 9,044; Total

Annual Responses: 10,080,000; Total Annual Hours: 2,520,000.

2. Type of Information Collection Request: Reinstatement, without

change, of a previously approved collection for which approval has

expired; Title of Information Collection: Medicare/Medicaid Disclosure

of Ownership and Control Interest Statement and Supporting Regulations

in 42 CFR 420.200-.206, 455.100-.106 and 45 CFR 228.72-.73; Form No.:

HCFA-1513 (OMB# 0938-0086); Use: The Medicare/Medicaid Disclosure of

Ownership and Control Interest Statement must be used by State agencies

and HCFA regional offices to determine whether providers meet the

eligibility requirements for Titles 18 and 19 (Medicare and Medicaid)

and for grants under Titles V and XX. Review of ownership and control

is particularly necessary to prohibit ownership and control for

individuals excluded under Federal fraud statutes; Frequency: Other

(every 1 to 3 years); Affected Public: Business or other for-profit,

and Not-for-profit institutions; Number of Respondents: 92,000; Total

Annual Responses: 92,000; Total Annual Hours: 46,000.

To obtain copies of the supporting statement and any related forms

for the proposed paperwork collections referenced above, E-mail your

request, including your address and phone number, to

P[email protected], 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 Information Services, Information Technology

Investment Management Group, Division of HCFA Enterprise Standards,

Attention: Louis Blank, Room C2-26-17, 7500 Security

[[Page 39849]]

Boulevard, Baltimore, Maryland 21244-1850.

Dated: July 18, 1997.

John P. Burke III,

HCFA Reports Clearance Officer

Division of HCFA Enterprise Standards, Health Care Financing

Administration.

[FR Doc. 97-19516 Filed 7-23-97; 8:45 am]

BILLING CODE 4120-03-P