Agency Information Collection Activities: Proposed Collection; Comment Request

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[Document Identifier: HCFA-21, 21B, 21P, 21.11A, 21E]

Agency Information Collection Activities: Proposed Collection;

Comment Request

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 summary of proposed collections for public

comment. Interested persons are invited to send comments regarding the

burden estimate or any other aspect of this

[[Page 38839]]

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.

Type of Information Collection Request: New Collection;

Title of Information Collection: Children's Health Insurance

Program (CHIP) Budget and Expenditure System State Reporting Forms.

Form Nos.: HCFA-21, 21B, 21P, 21.11A, 21E;

Use: These forms will be used by State CHIP agencies to report CHIP

program budget projections and actual CHIP program benefits and

administrative expenditures, and the numbers of children being served

in the CHIP program, to the Health Care Financing Administration

(HCFA). The information provided by these new forms will be used by

HCFA to prepare the grant awards to States for the CHIP, to ensure that

the appropriate level of Federal payments for State expenditures under

the CHIP are made in accordance with the CHIP-related BBA legislative

provisions of 1997, and to track, monitor, and evaluate the numbers of

children being served by the CHIP.

Note: at this time Form HCFA-21E of this package is for States to

report the numbers of children, by service delivery system, that are

served in the States' CHIPs based on age categories. However, we are

continuing to work with the States to develop an appropriate format for

States to report the numbers of children, by service delivery system,

that are served in the CHIP based on Federal poverty income level

categories and under the age categories previously requested. When this

format is finalized it will be incorporated into Form HCFA-21E.

For a short description of the CHIP reporting forms, see below:

Form HCFA-21 Summary Sheet. Quarterly Children's Health

Insurance Program Statement of Expenditures for Title XXI Summary

Sheet. This form summarizes the total expenditures in the State's CHIP

reported by the State for the reporting quarter.

Form HCFA-21. Children's Health Expenditures by Type of

Service for the Title XXI Program, Expenditures in this Quarter. States

use this form to report CHIP current quarter expenditures in accordance

with services categories authorized under title XXI.

Form HCFA-21B. Children's Health Insurance Program Budget

Report for the Title XXI Program State Expenditure Plan. States use

this form to report their budget projections each quarter for their

Title XXI CHIPs for the current and budget Federal fiscal years and

broken out by quarter.

Form HCFA-21P. Children's Health Expenditures by Type of

Service for the Title XXI Program, Prior Period Adjustments. States use

this form to report CHIP prior period adjustment expenditures claimed

in the submission quarter in accordance with services categories

authorized under title XXI.

Form HCFA-21.11A. Provider-Related Donations and Health

Care Related Taxes, Fees, and Assessments Received Under Section

1903(w) for Title XXI. States use this form to report CHIP-related

State receipts of provider related donations, and health care related

taxes, fees, and assessments.

Form HCFA-21E. Children's Health Insurance Program, Number

of Children Served. States use this form to report the numbers of

children, by service delivery system, that are served in the States'

CHIPs based on age categories.

Note: HCFA is working with States to develop an appropriate

format for States to report numbers of children, by service delivery

system, that are served in the CHIP based on Federal poverty income

level categories and under the age categories previously requested.

When the format is finalized it will be incorporated into this form.

Frequency: Quarterly;

Affected Public: State and Federal government;

Number of Respondents: 56;

Total Annual Responses: 224;

Total Annual Hours: 7,840.

To obtain copies of the supporting statement for the proposed

paperwork collections referenced above, access HCFA's WEB SITE ADDRESS

at http://www.hcfa.gov/regs/prdact95.htm, or 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, Security and Standards Group, Division of HCFA

Enterprise Standards, Attention: John Rudolph, Room C2-26-17, 7500

Security Boulevard, Baltimore, Maryland 21244-1850.

Dated: July 9, 1998.

John P. Burke III,

HCFA Reports Clearance Officer, Division of HCFA Enterprise Standards,

Security and Standards Group, Health Care Financing Administration.

[FR Doc. 98-19256 Filed 7-17-98; 8:45 am]

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