[Federal Register Volume 61, Number 178 (Thursday, September 12, 1996)]
[Notices]
[Pages 48157-48158]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-23327]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
[HCFA-588, 43, 116, 668A]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
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, without
change, of a previously approved collection for which approval has
expired; Title of Information Collection: Authorization Agreement for
Electronic Funds Transfer; Form No.: HCFA-588; Use:
[[Page 48158]]
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 Hours: 9,819.
2. Type of Information Collection Request: Reinstatement, without
change, of a previously approved collection for which approval has
expired; Title of Information Collection: Application of 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 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 Hours: 20,000.
4. Type of Information Collection Request: Reinstatement, without
change, of a 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 evaluation the survey process. The
form is completed in conjunction with the HCFA form 668B. This
information will 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 State, Local or Tribal Governments; Number of
Respondents: 1,560; 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 30 days of this notice
directly to the HCFA Paperwork Clearance 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.
Date: September 4, 1996.
Edwin J. Glatzel,
Director, Management Planning and Analysis Staff, Office of Financial
and Human Resources, Health Care Financing Administration.
[FR Doc. 96-23327 Filed 9-11-96; 8:45 am]
BILLING CODE 4120-03-P
