[Federal Register Volume 61, Number 173 (Thursday, September 5, 1996)]
[Notices]
[Page 46815]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22548]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

AGENCY: Health Care Financing Administration, HHS.
    In compliance with the Paperwork Reduction Act of 1995 (44 U.S.C. 
3501 et seq.), the Health Care Financing Administration (HCFA), 
Department of Health and Human Services, has submitted to the Office of 
Management and Budget (OMB) the following proposals 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 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.
    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 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 Responses: 1,560; Total Annual Hours: 
390.
    To obtain copies of the supporting statement and any related forms, 
E-mail your request, including your address and phone number, 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 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: August 27, 1996.
Edwin J. Glatzel,
Director, Management Planning and Analysis Staff, Office of Financial 
and Human Resources, Health Care Financing Administration.
[FR Doc. 96-22548 Filed 9-4-96; 8:45 am]
BILLING CODE 4120-03-P