This data collection is approved through 8/95. The pilot to combine forms IHS-43 and IHS-64 projected to be completed by October 1, 1993ha been further delayed. IHS is encouraged to complete this demonstratio by March 31, 1995.
Inventory as of this Action
Requested
Previously Approved
08/31/1995
08/31/1995
344,136
0
0
60,316
0
0
0
0
0
PROVIDES A DESCRIPTION OF THE PATIENT'S DIAGNOSIS, PROCEDURES PERFORME HEALTH CARE SERVICES PROVIDED, AND FEE CHARGED TO IHS. SERVES AS A LEGAL DOCUMENT FOR HEALTH CARE RENDERED. COPIES OF THE FORM ARE USED FOR BILLING PURPOSES AND THE PROVISION OF PROGRAM HEALTH STATISTICS.
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.
INDIAN HEALTH SERVICE, HOSPITAL, DENTAL, AND OTHER CONTRACT HEALTH SERVICE REPORTS