[Federal Register Volume 65, Number 175 (Friday, September 8, 2000)]
[Notices]
[Pages 54536-54537]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-23081]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[Document Identifier: HCFA-216 & HCFA-2384]


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.
    (1) Type of Information Collection Request: Extension of a 
currently approved collection;
    Title of Information Collection: Organ Procurement Organization/
Histocompatibility Laboratory Statement of Reimbursable Costs, Manual 
Instructions and Supporting Regulations Contained in 42 CFR 413.20 and 
413.24;
    Form No.: HCFA-216 (OMB No. 0938-0102);
    Use: This form is required by statute for participation in the 
Medicare program. The information is used to determine reasonable costs 
incurred to furnish treatment to End Stage Renal Disease (ESRD) 
patients by Organ Procurement Organizations and Histocompatibility 
Laboratories.
    Frequency: Annually;
    Affected Public: Business or other for-profit, Not-for-profit 
institutions, and State, Local or Tribal Government;
    Number of Respondents: 108;
    Total Annual Responses: 108;
    Hours: 4,860.

    (2)Type of Information Collection Request: Extension of a currently 
approved collection;
    Title of Information Collection: Third Party Premium Billing 
Request and Supporting Regulations in 42 CFR 408.6;
    Form No.: HCFA-2384 (OMB 0938-0041);
    Use: The Third Party Premium Billing Request is used as an 
authorization form to designate that a family member or other 
interested party receive the Medicare premium bill and pay it on behalf 
of a Medicare beneficiary.
    Frequency: On occasion;
    Affected Public: Individuals or Households;
    Number of Respondents: 15,000;
    Total Annual Responses: 15,000;
    Total Annual Hours: 6,250.
    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.

[[Page 54537]]

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, DC 20503.

    Dated: August 9, 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. 00-23081 Filed 9-7-00; 8:45 am]
BILLING CODE 4120-03-P