[Federal Register Volume 61, Number 119 (Wednesday, June 19, 1996)]
[Notices]
[Pages 31141-31142]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-15612]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
Agency Information Collection Activities: Proposed Collection;
Comment Request
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, is
publishing the following summaries of proposed collections for public
comment. Interested persons are invited to send comments regarding this
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, without
change, of previously approved collection for which approval has
expired; Title of Information Collection: Authorization Agreement for
Electronic Funds Transfer; Form No.: HCFA-588; Use: This information is
needed to allow providers to receive funds electronically in their
bank; Frequency: On occasion; Affected Public: Business or other for
profit, not for profit institutions; Number of Respondents: 78,550;
Total Annual Responses: 78,550; Total Annual Hours: 9,819. Number of
Respondents: 16,000; Total Annual Responses: 16,000; Total Annual
Hours: 20,000.
2. Type of Information Collection Request: Reinstatement, without
change, of previously approved collection for which approval has
expired; Title of Information Collection: Application for Health
Insurance Under Medicare for Individuals with Chronic Renal Disease;
Form No.: HCFA-43; Use: This form is used as a standard method of
eliciting information necessary to determine entitlement to Medicare
under the end stage renal disease provision of the law; Frequency: On
occasion; Affected Public: Individuals and households, Federal
government; Number of Respondents: 80,000; Total Annual Responses:
80,000; Total Annual Hours: 34,400.
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Clinical
Laboratory Improvement Amendments Application Form; Form No.: HCFA-116;
Use: This application is completed by entities performing laboratory
testing on human specimens for health purposes; Frequency: Biennially;
Affected Public: Business or other for profit, not for profit
institutions, Federal government and State, local or tribal
governments; Number of Respondents: 16,000; Total Annual Responses:
16,000; Total Annual Hours: 20,000.
4. Type of Information Collection Request: Reinstatement, without
change, of previously approved collection for which approval has
expired; Title of Information Collection: Post Laboratory Survey
Questionnaire-Surveyor; Form No.: HCFA-668A; Use: This survey provides
the surveyor with an opportunity to evaluate the survey process. The
form is completed in conjunction with the HCFA form 668B. This
information with help HCFA evaluate the entire survey process from the
surveyor's prospective; Frequency: Biennially; Affected Public:
Business or other for profit, not for profit institutions, Federal
government and
[[Page 31142]]
State, local or tribal governments; Number of Respondents: 1,560; Total
Annual Responses: 1,560; Total Annual Hours: 390.
5. Type of Information Collection Request: Reinstatement, without
change, of previously approved collection for which approval has
expired; Title of Information Collection: Post Laboratory Survey
Questionnaire-Laboratory; Form No.: HCFA-668B; Use: This survey
provides the laboratory with an opportunity to evaluate the survey
process. The form is completed in conjunction with the HCFA form 668A.
This information will help HCFA evaluate the entire survey process from
the laboratory's prospective; Frequency: Biennially; Affected Public:
Business or other for profit, not for profit institutions, Federal
government and State, local or tribal governments; Number of
Respondents: 1,560; Total Annual Responses: 1,560: Total Annual Hours:
390.
Total Annual Hours: 390.
To obtain copies of the supporting statement for the proposed
paperwork collections referenced above, access HCFA's WEB SITE ADDRESS
at [http://www.hcfa.gov], or to obtain the supporting statement and any
related forms, E-mail your request, including your address and phone
number, to Paperwork@hcfa.gov, or call the Reports Clearance Office on
(410) 786-1326. Written comments and recommendations for the proposed
information collections must be mailed within 60 days of this notice
directly to HCFA Paperwork Clearance Officer designated at the
following address: HCFA, Office of Financial and Human Resources,
Management Planning and Analysis Staff, Attention: John Burke, Room C2-
26-17, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.
Dated: June 13, 1996.
Kathleen B. Larson,
Director, Management Planning and Analysis Staff, Office of Financial
and Human Resources, Health Care Financing Administration.
[FR Doc. 96-15612 Filed 6-18-96; 8:45 am]
BILLING CODE 4120-03-P
