01-21977. Agency Information Collection Activities: Submission for OMB Review; 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 summary 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.

Type of Information Collection Request: New collection; Title of Information Collection: State Health Insurance Assistance Program (SHIP) Client Contact Form; Form No.: HCFA-10028 (OMB# 0938-NEW); Use: The State Health Insurance Assistance Program (SHIP) Client Contact Form will be completed by SHIP counselors at each counseling event to collect SHIP performance data, which will then be accumulated and analyzed to measure performance; Frequency: Semi-annually, Annually; Affected Public: State, local, or tribal gov.; Number of Respondents: 53; Total Annual Responses: 265; Total Annual Hours: 132.5. To obtain copies of the supporting statement and any related forms for the proposed paperwork collections referenced above, access HCFA's Web Site address at http://www.hcfa.gov/​regs/​prdact95.htm,, or E-mail your request, including your address, phone number, OMB number, and HCFA document identifier, to [e-mail], or call the Reports Clearance Office on [phone]. Written comments and recommendations for the proposed information collections must be mailed within 30 days of this notice directly to the OMB desk officer: OMB Human Resources and Housing Branch, Attention: Wendy Taylor, New Executive Office Building, Room 10235, Washington, DC 20503.

Dated: August 15, 2001.

John P. Burke III,

HCFA Reports Clearance Officer, HCFA Office of Information Services, Security and Standards Group, Division of HCFA Enterprise Standards.