THE HCFA 372,
AMBULATORY SURGICAL CENTER : CERTIFICATION AND SURVEY REPORT IS
SUBJECT TO OMB APPROVAL SINCE IT IS AN INFORMATION COLLECTIO
IMPOSED UPON THE STATES WHICH ARE CONTRACTORS TO THE FEDERAL
GOVERNMEN TO COMPLY WITH THIS INFORMATION COLLECTION REQUIREMENT,
THE STATES MUST COMPILE AND MAINTAIN RECORDS. TO ADMINISTER THIS
COLLECTION, THE STATES VISIT CENTERS, REVIEW RECORDS, OBSERVE
CONDITIONS, AND ASK QUESTIONS NEEDED TO EVALUATE THE FACILITY.
ACCORDINGLY, THE BURDEN FOR THIS SURVEY INCLUDES ALL THE BURDEN
IMPOSED ON THE STATES AND ALL THE BURDEN THAT THE STATES IMPOSE ON
THE FACILITIES DURING THE COURSE OF THE SURVEY. THE HCFA 372 IS
APPROVED FOR USE THROUGH OCTOBER 1984. THE OMB NUMBER 0938-0266
MUST BE PRINTED ON THE FRONT PAGE OF THE HCFA 372 FAILURE TO
REFLECT OMB APPROVAL ON THE HCFA 372 WILL INVALIDATE THE HCFA
REQUIREMENT THAT STATES UTILIZE THE HCFA 372 TO SURVEY AMBULATORY
SURGICAL CENTERS. HHS SHALL SUBMIT THE PRINTED HCFA 372 REFLECTING
THE OMB APPROVAL NUMBER WITHIN SIXTY DAYS OF THIS APPROVAL.
Inventory as of this Action
Requested
Previously Approved
10/31/1984
10/31/1984
400
0
0
23,700
0
0
0
0
0
IN ORDER TO PARTICIPATE IN THE
MEDICARE PROGRAM AMBULATORY SURGICAL CENTERS MUST MEET THE FEDERAL
CONDITIONS OF PARTICIPATION. THIS INFORMATION COLLECTION IS USED TO
DETERMINE COMPLIANCE.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.