Agency Information Collection Activities: Submission for OMB Review; Comment Request

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[HCFA-1514]


Agency Information Collection Activities: Submission for OMB 
Review; 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, has 
submitted to the Office of Management and Budget (OMB) the following 
proposal for the collection of information. Interested persons are 
invited to send comments regarding the 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.
    Type of Information Collection Request: Extension of currently 
approved collection; Title of Information Collection: Hospital Request 
for Certification in the Medicare/Medicaid Programs; Form No.: HCFA-
1514; Use: Section 1861 of the Social Security Act and 42 CFR part 482 
requires hospitals to be certified to participate in the Medicare/
Medicaid programs. As part of the certification process, providers must 
complete form HCFA-1514. This certification form is a facility 
identification and screening form used to initiate the certification 
process and to determine if the provider has sufficient personnel to 
participate in the Medicare/Medicaid programs. Frequency: Annually; 
Affected Public: State, Local or Tribal Government; Number of 
Respondents: 2,500; Total Annual Responses: 2,500; Total Annual Hours: 
625.
    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 to obtain supporting 
statement and any related forms, E-mail your request, including your 
address and phone number, 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 30 days of this notice directly to the HCFA Paperwork Clearance 
Officer designated at the following address:

OMB Human Resources and Housing Branch, Attention: Allison Eydt, New 
Executive Office Building, Room 10235, Washington, DC. 20503

    Dated: April 8, 1997.
Edwin J. Glatzel,
Director, Management Analysis and Planning Staff, Office of Financial 
and Human Resources, Health Care Financing Administration.
[FR Doc. 97-9708 Filed 4-15-97; 8:45 am]
BILLING CODE 4120-03-M  

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