[Federal Register Volume 62, Number 224 (Thursday, November 20, 1997)]
[Notices]
[Page 62065]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-30472]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[Document Identifier: HCFA-565]


Agency Information Collection Activities: Submission For OMB 
Review; 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: Reinstatement, without 
change, of a previously approved collection for which approval has been 
expired; Title of Information Collection: Medicare Qualification 
Statement for Federal Employees and Supporting Regulations in 42 CFR 
406.15; Form No.: HCFA-565 (OMB #0938-0501); Use: The HCFA-565 is 
completed by an individual filing for hospital insurance (HI) benefits 
(Part A) based upon their federal employment. This information is 
necessary to determine if HCFA/SSA can use federal employment prior to 
1983 to qualify for free Part A. The data is passed to the HI master 
record, the Enrollment Data Base (EDB). An HI record showing 
appropriate entitlement is established an if applicable, a Medicare 
card is issued.; Frequency: Other (one time only); Affected Public: 
Individuals or Households, and Federal Government; Number of 
Respondents: 4,300; Total Annual Responses: 4,300; Total Annual Hours: 
717.
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, E-mail your 
request, including your address, phone number, OMB number, and HCFA 
document identifier, 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 OMB desk officer: OMB 
Human Resources and Housing Branch, Attention: Allison Eydt, New 
Executive Office Building, Room 10235, Washington, D.C. 20503.

    Dated: November 12, 1997.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA Office of Information Services, 
Information Technology Investment Management Group, Division of HCFA 
Enterprise Standards.
[FR Doc. 97-30472 Filed 11-19-97; 8:45 am]
BILLING CODE 4120-03-P