[Federal Register Volume 64, Number 173 (Wednesday, September 8, 1999)]
[Notices]
[Page 48844]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-23312]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[HCFA-R-285]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Health Care Financing Administration, HHS.
action: Comment request.
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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: Extension of a currently
approved collection;
Title of Information Collection: Request for Retirement Benefit
Information;
Form No.: HCFA-R-285 (OMB 0938-0769);
Use: This form will be used to obtain information regarding whether
a beneficiary is receiving retirement payments based on State or local
government employment, how long the claimant worked for the State or
local government employer, and whether the former employer or pension
plan subsidizes the beneficiary's Part A premium. The purpose in
collecting this information is to determine and provide those eligible
beneficiaries, with free Part A Medicare coverage.;
Frequency: On Occasion;
Affected Public: State, Local or Tribal Government, and Individuals
or Households;
Number of Respondents: 1,500;
Total Annual Responses: 1,500;
Total Annual Hours: 375.
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 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 the HCFA Paperwork Clearance
Officer designated at the following address: HCFA, Office of
Information Services, Security and Standards Group, Division of HCFA
Enterprise Standards, Attention: Dawn Willinghan, Room N2-14-26, 7500
Security Boulevard, Baltimore, Maryland 21244-1850.
Dated: August 26, 1999.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA Office of Information Services,
Security and Standards Group, Division of HCFA Enterprise Standards.
[FR Doc. 99-23312 Filed 9-7-99; 8:45 am]
BILLING CODE 4120-03-P
