Document Headings

                    Document headings vary by document type but may contain                    the following:                  
                -                       the agency or agencies that issued and signed a document                    
                -                       the number of the CFR title and the number of each part                      the document amends, proposes to amend, or is directly                      related to                    
                -                       the agency docket number / agency internal file number                    
                -                       the RIN which identifies each regulatory action listed in                      the Unified Agenda of Federal Regulatory and Deregulatory                      Actions                    

                    See the                                          Document Drafting Handbook                                        for more details.                  

###### Department of Health and Human Services

###### Health Care Financing Administration 

          - [Document Identifier: HCFA-R-1500] 

# 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 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:*                         Health Insurance Common Claims Form and Supporting Regulations in 42 CAR 414.40, 424.32, and 424.44;                         *Form No.:*                         HCFA-1500, 1490U, and 1490S (OMB# 0938-0008);                         *Use:*                         This form is a standardized form for use in the Medicare/Medicaid programs to apply for reimbursement for covered services;                         *Frequency:*                         On occasion;                         *Affected Public:*                         Business or other for-profit, Not-for-profit institutions;                         *Number of Respondents:*                         1,321,417;                         *Total Annual Responses:*                         717,876,097; Total Annual Hours: 44,460,460.                     

                        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 Paperwork@hcfa.gov, 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                               ( print page 30415)                            the OMB desk officer: OMB Human Resources and Housing Branch, Attention: Allison Eydt, New Executive Office Building, Room 10235, Washington, D.C. 2050.                    

Dated: April 17, 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. 00-11846 Filed 5-10-00; 8:45 am] 

BILLING CODE 4120-03-P