[Federal Register Volume 63, Number 127 (Thursday, July 2, 1998)]
[Notices]
[Page 36249]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-17557]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[Document Identifier: HCFA-379]


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.
    Type of Information Collection Request: Extension of a currently 
approved collection; Title of Information Collection: The Financial 
Statement of Debtor and Supporting Regulation 42 CFR 405.376; Form No.: 
HCFA-379, OMB #0938-0270; Use: This form is used to collect financial 
information which is needed to evaluate requests from physician/
suppliers to pay indebtness under extended repayment schedule, or to 
compromise a debt for less than the full amount. Frequency: As needed; 
Affected Public: Business or other for-profit, Not-for-profit 
institutions; Number of Respondents: 500; Total Annual Responses: 500; 
Total Annual Hours: 1,000.
    To obtain copies of the supporting statement for the proposed 
paperwork collections referenced above, 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 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: June 18, 1998.
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. 98-17557 Filed 7-1-98; 8:45 am]
BILLING CODE 4120-03P