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

###### Health Care Financing Administration

          - [Document Identifier: HCFA-R-231]

# 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,                               ( print page 21988)                            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 Request:*                         Extension of a currently approved collection;                         *Title of Information Collection:*                         Medicare+Choice (M+C) Provider Sponsored Organization (PSO) Waiver Request Form and Supporting Regulations in 42 CFR 422.370-422.378;                         *Form Number:*                         HCFA-R-231 (0938-0722);                         *Use:*                         The PSO waiver request form is for use by PSO's that do not have a State risk-bearing entity licence and that wish to enter into a M+C contract with HCFA to provide prepaid health care services to eligible Medicare beneficiaries. HCFA will use the information requested on this form to determine whether the applicant is eligible for a waiver of the state licensure requirement for M+C organizations as allowed under section 1855(a)(2) of the Social Security Act.;                         *Frequency:*                         One-time.;                         *Affected Public:*                         Business or other for-profit, Not-for-profit institutions, and Federal Government.;                         *Annual Number of Respondents:*                         10.;                         *Total Annual Responses:*                         10.;                         *Total Annual Hours Requested:*                         100.                    

                        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 60 days of this notice directly to the HCFA Paperwork Clearance Officer designated at the following address: HCFA, Office of Information Services, Security and Standards Group, Division of HCFA Enterprise Standards, Attention: Dawn Willinghan, HCFA-R-231, Room N2-14-26, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.                    

Dated: April 23, 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. 01-10882 Filed 5-1-01; 8:45 am]

BILLING CODE 4120-03-P