[Federal Register Volume 63, Number 80 (Monday, April 27, 1998)]
[Notices]
[Page 20639]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-11124]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration
[HCFA-379]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

    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 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 regulation 42 CFR 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 physician/
suppliers to pay indebtness under extended repayment schedule, or to 
compromise a debt for less than the full amount. Frequency: As needed; 
Affected Public: Business or other for-profit, Not-for-profit 
institutions; 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, or any related forms, E-mail 
your request, including your address and phone number, to 
P<a href="/cdn-cgi/l/email-protection#7a1b0a1f080d1508113a12191c1b541d150c"><span class="__cf_email__" data-cfemail="c2a3b2a7b0b5adb0a982aaa1a4a3eca5adb4">[email protected]</span></a>, 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, Information Technology 
Investment Management Group, Division of HCFA Enterprise Standards, 
Attention: John Rudolph, Room C2-26-17, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850.

    Dated: April 20, 1998.
John P. Burke III,
HCFA Reports Clearance Officer, Division of HCFA Enterprise Standards, 
Health Care Financing Administration.
[FR Doc. 98-11124 Filed 4-24-98; 8:45 am]
BILLING CODE 4120-03-P


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