[Federal Register Volume 65, Number 86 (Wednesday, May 3, 2000)]
[Notices]
[Page 25737]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-11035]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[Document Identifier: HCFA-566]


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: Medicare, Managed Care 
Disenrollment Form;
    Form No.: HCFA-566 (OMB #0938-0507);
    Use: This form is used to disenroll from managed care plans. This 
is to be used in Social Security Field Offices to allow Medicare 
beneficiaries to disenroll from a managed care plan;
    Frequency: On occasion;
    Affected Public: Individuals or households, business or other for-
profit, Not-for-profit institutions, and Federal Government;
    Number of Respondents: 85,000;
    Total Annual Responses: 85,000;
    Total Annual Hours: 2,805.
    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/regs/prdact95.htm, or E-mail your request, 
including your address and phone number, to [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: April 10, 2000.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA, Office of Information Services, 
Security and Standards Group, Division of HCFA Enterprise Standards.
[FR Doc. 00-11035 Filed 5-2-00; 8:45 am]
BILLING CODE 4120-03-P