[Federal Register Volume 66, Number 14 (Monday, January 22, 2001)]
[Notices]
[Pages 6628-6629]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-1724]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[Document Identifier: HCFA-10027]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Health Care Financing Administration, DHHS.
    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,

[[Page 6629]]

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 Request: New collection; Title of Information 
Collection: Ambulance Attachment Form; Form Number: HCFA-10027 (OMB 
approval #: 0938-NEW); Use: This form is used by ambulance suppliers in 
Missouri to report information needed to process their claims; it is an 
attachment to the HCFA form 1491, which is used to submit ambulance 
claims; Frequency: On occasion; Affected Public: Business or other for-
profit, Not-for-profit institutions, State, local, or tribal gov; 
Number of Respondents: Total Annual Responses: 5,000; Total Annual 
Hours Requested: 167 hours.
    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 [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: Julie Brown, HCFA-10027; Room N2-14-
26, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

    Dated: January 10, 2001.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA Office of Information Services, 
Security and Standards Group, Division of HCFA Enterprise Standards.
[FR Doc. 01-1724 Filed 1-19-01; 8:45 am]
BILLING CODE 4120-03-U