[Federal Register Volume 65, Number 179 (Thursday, September 14, 2000)]
[Notices]
[Page 55635]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-23625]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[Document Identifier: HCFA-901-1 and HCFA-1763]


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: Revision of a currently 
approved collection;
    Title of Information Collection: Qualification Application and 
Supporting Regulations in 42 CFR Section 417.408 and 417.143;
    Form No.: HCFA-901-1 (OMB# 0938-0470);
    Use: Prepaid health plans must meet certain regulatory requirements 
to be federally qualified health maintenance organizations. This 
application is the collection form used to obtain the information from 
health plans that allow HCFA staff to determine compliance with the 
regulations;
    Frequency: Other: One-time;
    Affected Public: Business or other for-profit, not-for-profit 
institutions, and State, Local, or Tribal Government;
    Number of Respondents: 35;
    Total Annual Responses: 35;
    Total Annual Hours: 3,500.

    (2) Type of Information Collection Request: Extension of a 
currently approved collection;
    Title of Information Collection: Request for Termination of Premium 
Hospital and/or Supplementary Medical Insurance and Supporting 
Regulations in 42 CFR 406.28 and 407.27;
    Form No.: HCFA-1763 (OMB No. 0938-0025);
    Use: The HCFA-1763 is used by beneficiaries to request voluntary 
termination from premium hospital and/or supplementary medical 
insurance;
    Frequency: One time only;
    Affected Public: Individuals or Households, Federal Government, and 
State, Local or Tribal Government;
    Number of Respondents: 14,000;
    Total Annual Responses: 14,000;
    Total Annual Hours: 5,833.
    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, DC 20503.

    Dated: August 28, 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. 00-23625 Filed 9-13-00; 8:45 am]
BILLING CODE 4120-03-P