[Federal Register: November 25, 1998 (Volume 63, Number 227)]
[Notices]               
[Page 65213]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr25no98-118]

-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[Document Identifier: HCFA-287 & HCFA-1491]

 
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 summary 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 Office Cost Statement and 
Supporting Regulations in 42 CFR Section 413.17;
    Form No.: HCFA-287 (OMB# 0938-0202);
    Use: Medicare law permits components of chain organizations to be 
reimbursed for certain costs incurred by the Home Offices of the chain. 
The Home Office Cost Statement is required by the fiscal intermediary 
to verify Home Office Costs claimed by the components. This requires 
that the provider include in its costs, the costs incurred by the 
related organization in furnishing such services, supplies or 
facilities.
    Frequency: Annually;
    Affected Public: Not-for-profit institutions, Business or other 
for-profit;
    Number of Respondents: 1,231;
    Total Annual Responses: 1,231;
    Total Annual Hours: 573,646.
    (2) Type of Information Collection Request: Extension of a 
currently approved collection;
    Title of Information Collection: Request for Medicare Payment--
Ambulance and Supporting Regulations in 42 CFR Section 410.40 and 
424.124;
    Form No.: HCFA-1491 (OMB# 0938-0042);
    Use: This form is used by physicians, suppliers, and beneficiaries 
to request payment of Part B Medicare services. It is used to apply for 
reimbursement for ambulance services.
    Frequency: On occasion;
    Affected Public: Business or other for-profit, Individuals or 
households, and Not-for-profit Institutions;
    Number of Respondents: 9,634,435;
    Total Annual Responses: 9,634,435;
    Total Annual Hours: 406,251.
    To obtain copies of the supporting statement and any related forms 
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, phone number, OMB number, and 
HCFA document identifier, to Paperwork@hcfa.gov, 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: Louis Blank, Room N2-14-26, 7500 
Security Boulevard, Baltimore, Maryland 21244-1850.

    Dated: November 10, 1998.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA Office of Information Services, 
Security and Standards Group, Division of HCFA Enterprise Standards.
[FR Doc. 98-31536 Filed 11-24-98; 8:45 am]
BILLING CODE 4120-03-P