Approved for use
through 1/98 under the conditions that: 1) in the next submission,
HCFA thoroughly addresses OMB previous clearance remarks dated
8/29/94; and 2) HCFA immediately incor- porates in the
forms/instructions the disclosure statements required by the
Paperwork Reduction Act of 1995 and its imple- menting regulations.
HCFA must provide OMB a copy of the revised forms/instructions for
the public record.
Inventory as of this Action
Requested
Previously Approved
01/31/1998
01/31/1998
08/31/1996
7,000
0
380,560
4,599,000
0
4,433,560
50,000
0
0
This form is required by statute and
regulation for participation in the Medicare program. The
information is used to determine final payment for medicare.
Hospitals and related complexes are the main users.
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.
Hospital and Hospital Healthcare Complex Cost Report