[Federal Register Volume 61, Number 198 (Thursday, October 10, 1996)]
[Notices]
[Page 53228]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-26003]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[Document Identifier: HCFA-R-96]

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. HFCA-R-96 Type of Information Collection Request: Extension of 
currently approved collection; Title of Information Collection: 
Emergency and Foreign Hospital Services-Beneficiary Statement In 
Canadian Travel Claims and Supporting Regulation 42 CFR 424.123; Form 
No.: HCFA-R-96; Use: This form is completed by beneficiaries, 
representative, or assignees to support claims for payments for 
Medicare covered emergency services provided in Canada. 42 CFR 424.123 
is the regulation supporting this collection of information; Frequency: 
On occasion; Affected Public: Individuals or households; Number of 
Respondents: 1,100; Total Annual Responses: 1,100; Total Annual Hours: 
275.
    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 60 days of this notice 
directly to the HCFA Paperwork Clearance Officer designated at the 
following address: HCFA, Office of Financial and Human Resources, 
Management Analysis and Planning Staff, Attention: John Burke, Room C2-
26-17, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.
    Dated: October 3, 1996.
Edwin J. Glatzel,
Director, Management Analysis and Planning Staff, Office of Financial 
and Human Resources, Health Care Financing Administration.
[FR Doc. 96-26003 Filed 10-9-96; 8:45 am]
BILLING CODE 4120-03-M