[Federal Register Volume 60, Number 239 (Wednesday, December 13, 1995)]
[Notices]
[Pages 64067-64068]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-30393]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration


Public Information Collection Requirements Submitted for Public 
Comment and Recommendations

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, 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, with change, 
of a previously approved collection for which approval has expired.
Title of Information Collection: Request for Medicare Payment-
Ambulance.
Form No.: HCFA-1491.
Use: This form is completed on an ``occasional'' basis by beneficiaries 
and/or ambulance services. It is also submitted to a Medicare carrier 
to request payment for ambulance services.
Frequency: On occasion.
Affected Public: Individuals or households, business or other for-
profit, not-for-profit institutions.
Number of Respondents: 8,513,300.
Total Annual Hours Requested: 1,418,883.
    To request copies of the proposed paperwork collections referenced 
above, E-mail your request, including your address, to 
P[email protected], or call the Reports Clearance Office on (410) 786-
1326. Written comments and recommendations for the proposed information 
collections should be sent 

[[Page 64068]]
within 30 days of this notice directly to the OMB Desk 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.

    Dated: December 5, 1995.
Kathleen B. Larson,
Director, Management Planning and Analysis Staff, Office of Financial 
and Human Resources, Health Care Financing Administration.
[FR Doc. 95-30393 Filed 12-12-95; 8:45 am]
BILLING CODE 4120-03-P