THE HCFA 378 AND
THE INFORMATION COLLECTION REQUEST, FOR 416.43 AND 416.47 ARE
APPROVED. APPROVAL IS GRANTED ON THE CONDITION THAT HHS PERFORM A
COMPREHENSIVE REVIEW OF ALL OTHER REGULATORY PROVISIONS UNDER
SUBPART B AND SUBMIT ALL REPORTING AND RECORDKEEPING REQUIREMENTS
TO OMB FOR REVIEW PURSUANT TO 5 U.S.C. 1320(A).
Inventory as of this Action
Requested
Previously Approved
10/31/1986
10/31/1986
10/31/1984
215
0
400
2,308
0
6,500
0
0
0
IN ORDER TO PARTICIPATE IN THE
MEDICARE/MEDICAID PROGRAM AS AN ASC PROVIDERS MUST MEET FEDERAL
CONDITIONS FOR COVERAGE. THE CERTIFICATIO FORM IS NEEDED TO
DETERMINE IF PROVIDERS MEET AT LEAST PRELIMINARY REQUIREMENTS. THE
SURVEY FORM IS USED TO RECORD PROVIDER COMPLIANCE WITH THE
INDIVIDUAL CONDITIONS AND REPORT TO HCFA.
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.