[Federal Register Volume 60, Number 239 (Wednesday, December 13, 1995)]
[Notices]
[Pages 64067-64068]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-30393]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
Public Information Collection Requirements Submitted for Public
Comment and Recommendations
AGENCY: Health Care Financing Administration, HHS.
In compliance with the requirement of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the Health Care Financing
Administration (HCFA), Department of Health and Human Services, has
submitted to the Office of Management and Budget (OMB) the following
proposal for the collection of information. Interested persons are
invited to send comments regarding the burden estimate or any other
aspect of this collection of information, including any of the
following subjects: (1) The necessity and utility of the proposed
information collection for the proper performance of the agency's
functions; (2) the accuracy of the estimated burden; (3) ways to
enhance the quality, utility, and clarity of the information to be
collected; and (4) the use of automated collection techniques or other
forms of information technology to minimize the information collection
burden.
1. Type of Information Collection Request: Reinstatement, with change,
of a previously approved collection for which approval has expired.
Title of Information Collection: Request for Medicare Payment-
Ambulance.
Form No.: HCFA-1491.
Use: This form is completed on an ``occasional'' basis by beneficiaries
and/or ambulance services. It is also submitted to a Medicare carrier
to request payment for ambulance services.
Frequency: On occasion.
Affected Public: Individuals or households, business or other for-
profit, not-for-profit institutions.
Number of Respondents: 8,513,300.
Total Annual Hours Requested: 1,418,883.
To request copies of the proposed paperwork collections referenced
above, E-mail your request, including your address, to
Paperwork@hcfa.gov, or call the Reports Clearance Office on (410) 786-
1326. Written comments and recommendations for the proposed information
collections should be sent
[[Page 64068]]
within 30 days of this notice directly to the OMB Desk Officer
designated at the following address: OMB Human Resources and Housing
Branch, Attention: Allison Eydt, New Executive Office Building, Room
10235, Washington, D.C. 20503.
Dated: December 5, 1995.
Kathleen B. Larson,
Director, Management Planning and Analysis Staff, Office of Financial
and Human Resources, Health Care Financing Administration.
[FR Doc. 95-30393 Filed 12-12-95; 8:45 am]
BILLING CODE 4120-03-P
