[Federal Register Volume 66, Number 129 (Thursday, July 5, 2001)]
[Notices]
[Pages 35441-35442]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-16820]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[Document Identifier: HCFA-417]


Agency Information Collection Activities: Submission for OMB 
Review; 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

[[Page 35442]]

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: Hospice Request 
for Certification in the Medicare Program; Form No.: HCFA-417 (OMB# 
0938-0313); Use: The Hospice Request for Certification Form is used for 
hospice identification, screening, and to initiate the certification 
process. The information captured on this form is entered into a data 
base which assists HCFA in determining whether providers have 
sufficient personnel to participate in the Medicare program; Frequency: 
Annually; Affected Public: Business or other for-profit, Not-for-profit 
institutions, Federal Government, and State, local or tribal 
government; Number of Respondents: 2,286; Total Annual Responses: 
2,286; Total Annual Hours: 572.
    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 30 days of this notice directly to the OMB desk officer:OMB 
Human Resources and Housing Branch,Attention: Allison Eydt,New 
Executive Office Building, Room 10235,Washington, DC 20503.

    Dated: May 22, 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. 01-16820 Filed 7-3-01; 8:45 am]
BILLING CODE 4120-03-P