[Federal Register Volume 66, Number 154 (Thursday, August 9, 2001)]
[Notices]
[Page 41878]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-19939]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare and Medicaid Services

[Document Identifier: HCFA-379]


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 Centers for Medicare and Medicaid 
Services (CMS), 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: The Financial 
Statement of Debtor and Supporting Regulations in 42 CFR, Section 
405.376;
    Form No.: HCFA-379 (OMB# 0938-0270);
    Use: This form is used to collect financial information which is 
needed to evaluate requests from physicians/suppliers to pay 
indebtedness under an extended repayment schedule, or to compromise a 
debt less than the full amount.;
    Frequency: Other: As needed;
    Affected Public: Business or other for-profit, and individuals or 
households;
    Number of Respondents: 500;
    Total Annual Responses: 500;
    Total Annual Hours: 1,000.
    To obtain copies of the supporting statement for the proposed 
paperwork collections referenced above, access CMS'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: July 13, 2001.
John P. Burke III,
CMS Reports Clearance Officer, CMS, Office of Information 
Services,Security and Standards Group, Division of CMS Enterprise 
Standards.
[FR Doc. 01-19939 Filed 8-8-01; 8:45 am]
BILLING CODE 4120-03-P