Agency Information Collection Activities: Proposed Collection; Comment Request

[Federal Register Volume 64, Number 197 (Wednesday, October 13, 1999)]
[Notices]
[Pages 55483-55484]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-26696]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[Document Identifier: HCFA-R-297]


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 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: Existing collection in use 
without an OMB control number;
    Title of Information Collection: Request for Employment 
Information;
    Form No.: HCFA-R-297 (OMB# 0938-NEW);
    Use: This form is needed to determine whether a beneficiary can 
enroll in Part B Medicare and/or qualify for premium reduction. This 
form is used by the Social Security Administration to obrain 
information from employers regarding whether a Medicare beneficiary's 
coverage under a group health plan is based on current employment;
    Frequency: On occasion;
    Affected Public: Business or other for-profit;
    Number of Respondents: 5,000;
    Total Annual Responses: 5,000;
    Total Annual Hours: 750.
    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 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.

[[Page 55484]]

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: October 4, 1999.
John Parmigiani,
Manager, HCFA Office of Information Services, Security and Standards 
Group, Division of HCFA Enterprise Standards.
[FR Doc. 99-26696 Filed 10-12-99; 8:45 am]
BILLING CODE 4120-03-P