[Federal Register: January 12, 1999 (Volume 64, Number 7)] [Notices] [Page 1810-1811] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr12ja99-64] ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Care Financing Administration [Document Identifier: HCFA-0319, 0381, 1856/1893, and 1880/1882] 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: State Medicaid Eligibility Quality Control (MEQC) Sample Section Lists and Supporting Regulations in 42 CFR 431.800-431.865; Form No.: HCFA-0319 (OMB# 0938- 0147); Use: At the beginning of each month, State agencies are required to submit sample selection lists which identify all of the cases selected for review in the States' samples. These reviews are conducted to determine whether the sampled cases meet applicable State Title XIX eligibility requirements. The sample selection lists contain identifying information on Medicaid beneficiaries such as: State agency review number; beneficiary's name and address; the name of the county where beneficiary resides; and the Medicaid case number. The reviews are also used to assess beneficiary liability, if any, and to determine the amounts paid to provide Medicaid services for these cases.; Frequency: Monthly; Affected Public: State, Local or Tribal Government; Number of Respondents: 55; Total Annual Responses: 660; Total Annual Hours: 5,280. 2. Type of Information Collection Request: Extension of a currently approved collection; Title of Information Collection: Identification of Extension Units of Outpatient Physical Therapy (OPT) and Outpatient Speech Pathology (OSP) Providers and Supporting Regulations in 42 CFR 485.701-785.729; Form No.: HCFA-381 (OMB# 0938-0273); Use: Medicare requires OPT/OSP providers to be surveyed to determine compliance with Federal requirements. When an OPT/OSP provider furnishes services to locations other than their already certified premises (extension locations), those premises are considered to be part of the OPT/OSP provider and are subject to the same Medicare regulations as the primary location. This form is used by the State survey agencies and by the HCFA regional offices to identify and monitor extension locations to ensure their compliance with Federal requirements. The HCFA-381 form requests information such as: facility name, provider number, where services are rendered, and the number of OPT/OSP services rendered.; Frequency: Annually; Affected Public: Business or other for-profit; Number of Respondents: 2,300; Total Annual Responses: 2,300; Total Annual Hours: 575. 3. Type of Information Collection Request: Extension of a currently approved collection; Title of Information Collection: Request for Certification in the Medicare and/ or Medicaid Program to Provide Outpatient Physical Therapy (OPT) and/or Speech Pathology Services, Outpatient Physical Therapy Speech Pathology Survey Report and Supporting Regulations in 42 CFR 485.701-485.729; Form No.: HCFA-1856/ 1893 (OMB# 0938-0065); Use: The request for certification form is [[Page 1811]] used by State agency surveyors to determine if minimum Medicare eligibility requirements are being met by OPT providers. The survey report form records whether providers or suppliers are complying with HCFA health and safety requirements. The basic identifying information from this form is coded into the Online Survey Certification and Reporting System and serves as the information base for the creation of a record for future Federal certification and for monitoring activity.; Frequency: On occasion; Affected Public: Business or other for-profit; Number of Respondents: 1,700; Total Annual Responses: 1,700; Total Annual Hours: 446. 4. Type of Information Collection Request: Extension of a currently approved collection; Title of Information Collection: Request for Certification as Supplier of Portable X-ray Services under the Medicare/Medicaid Program for Portable X-ray Survey Report and Supporting Regulations in 42 CFR 405.1411-405.1416 and 486.100-486.110; Form No.: HCFA-1880/1882 (OMB# 0938-0027); Use: The Medicare program requires portable X-ray suppliers to be surveyed for health and safety standards. The HCFA-1880 is used by the surveyor to determine if a portable X-ray applicant meets the eligibility requirements. It also promotes data reduction or introduction, and retrieval from the Online Survey Certification and Reporting (OSCAR) System by the HCFA Regional Offices. The HCFA-1882 is the survey form that records survey results. The form is primarily a coding work sheet designed to facilitate data reduction and retrieval into the OSCAR system at the HCFA Regional Offices. Frequency: On occasion; Affected Public: Business or other for profit; Number of Respondents: 520; Total Annual Responses: 520; Total Annual Hours: 137. 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: January 4, 1999. John P. Burke III, HCFA Reports Clearance Officer, HCFA Office of Information Services, Security and Standards Group, Division of HCFA Enterprise Standards. [FR Doc. 99-669 Filed 1-11-99; 8:45 am] BILLING CODE 4120-03-P