THE REVISIONS TO
THE HCFA 1728 AS DESCRIBED IN THIS CLEARANCE REQUEST ARE NOT
APPROVED PURSUANT TO 5 CFR 1320.4[b]. THE HCFA 1728 PREVIOUSL
APPROVED UNDER 0938-0022 IS REINSTATED FOR USE THROUGH MARCH
31,1986 B WHICH HCFA SHALL ADDRESS ALL ISSUES RAISED IN A PUBLIC
COMMENT FILED B THE NATIONAL ASSOCIATION FOR HOME CARE DATED
NOVEMBER 14, 1985.
Inventory as of this Action
Requested
Previously Approved
03/31/1986
03/31/1986
4,400
0
0
600,000
0
0
0
0
0
PROVIDERS OF SERVICES PARTICIPATING IN
THE MEDICARE PROGRAM ARE REQUIR TO SUBMIT ANNUAL INFORMATION TO
ACHIEVE SETTELEMENT OF COSTS FOR HEALT CARE SERVICES RENDERED TO
MEDICARE BENEFICIARIES. THIS FORM IS FILED ANNUALLY BY FREESTANDING
HOME HEALTH AGENCIES PARTICIPATING IN THE MEDICARE
PROGRAM.
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.