[Federal Register Volume 64, Number 221 (Wednesday, November 17, 1999)]
[Notices]
[Page 62680]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-30029]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[HCFA-0043]


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 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: Extension of a currently 
approved collection;
    Title of Information Collection: Application for Health Insurance 
Benefits Under Medicare For Individuals With Chronic Renal Disease and 
Supporting Regulations in 42 CFR 406.13;
    Form No.: HCFA-0043 (OMB# 0938-0080);
    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. This form was developed 
to satisfy the requirements of law and regulations and provide a form 
for eligible individuals to apply for Medicare entitlement;
    Frequency: Other; one time only;
    Affected Public: Individuals or Households, Federal Government, and 
State, Local or Tribal Government;
    Number of Respondents: 60,000;
    Total Annual Responses: 60,000;
    Total Annual Hours: 26,000.
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access HCFA's 
Web Site address at http://www.hcfa.gov/regs/prdact95.htm, or 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 60 days of this notice directly to the HCFA Paperwork Clearance 
Officer designated at the following address: HCFA, Office of 
Information Services, Security and Standards Group, Division of HCFA 
Enterprise Standards, Attention: Dawn Willinghan, Room N2-14-26, 7500 
Security Boulevard, Baltimore, Maryland 21244-1850.

    Dated: November 8, 1999.
John Parmigiani,
Manager, HCFA Office of Information Services, Security and Standards 
Group, Division of HCFA Enterprise Standards.
[FR Doc. 99-30029 Filed 11-16-99; 8:45 am]
BILLING CODE 4120-03-P