Agency Information Collection Activities: Proposed Collection; Comment Request

[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 [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