[Federal Register Volume 61, Number 178 (Thursday, September 12, 1996)]
[Notices]
[Pages 48157-48158]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-23327]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
[HCFA-588, 43, 116, 668A]


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

    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, without 
change, of a previously approved collection for which approval has 
expired; Title of Information Collection: Authorization Agreement for 
Electronic Funds Transfer; Form No.: HCFA-588; Use:

[[Page 48158]]

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 Hours: 9,819.
    2. Type of Information Collection Request: Reinstatement, without 
change, of a previously approved collection for which approval has 
expired; Title of Information Collection: Application of 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 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 Hours: 20,000.
    4. Type of Information Collection Request: Reinstatement, without 
change, of a 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 evaluation 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 Hours: 390.
    To obtain copies of the supporting statement for the proposed 
paperwork collections referenced above, access HCFA's WEB SITE ADDRESS 
at http://www.hcfa.gov , or to obtain 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 must be mailed within 30 days of this notice 
directly to the HCFA Paperwork Clearance 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.

    Date: September 4, 1996.
Edwin J. Glatzel,
Director, Management Planning and Analysis Staff, Office of Financial 
and Human Resources, Health Care Financing Administration.
[FR Doc. 96-23327 Filed 9-11-96; 8:45 am]
BILLING CODE 4120-03-P