[Federal Register Volume 62, Number 158 (Friday, August 15, 1997)]
[Notices]
[Pages 43738-43739]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-21650]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[Document Identifier: HCFA-2384]
Agency Information Collection Activities: Submission for OMB
Review; Comment Request
AGENCY: Health Care Financing Administration.
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, 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: Reinstatement, without
change, of a previously approved collection for which approval has
expired; 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
[[Page 43739]]
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 and any related forms
for the proposed paperwork collections referenced above, E-mail your
request, including your address and phone number, to
P[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, D.C. 20503.
Dated: August 5, 1997.
John P. Burke III,
HCFA Reports Clearance Officer, Division of HCFA Enterprise Standards,
Health Care Financing Administration.
[FR Doc. 97-21650 Filed 8-14-97; 8:45 am]
BILLING CODE 4120-03-P