Approved for use
through 1/93 under the condition that in the next submission for
OMB review, HCFA re estimates the potential burden increase on the
home health industry of the additional break outs required in this
clearance package.
Inventory as of this Action
Requested
Previously Approved
01/31/1993
01/31/1993
07/31/1993
4,150
0
6,000
664,000
0
960,000
0
0
0
FORE IS REQUIRED TO BE FILED ANNUALLY
BY FREE-STANDING HOME HEALTH AGENCIES. THE DATA IS NEEDED FOR
STATISTICS AND TO EFFECTUATE FINAL SETTLEMENT OF COSTS FOR SERVICES
RENDERED TO MEDICARE BENEFICIARIES DURING THE PERIOD COVERED BY THE
COST REPORT.
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.