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-297] 

                    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, has submitted to the Office of Management and Budget (OMB) the following proposal for the collection of information. Interested                           ( print page 31940)                        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:*                     Existing collection in use without an OMB control number;                     *Title of Information Collection:*                     Request for Employment Information;                     *Form No.:*                     HCFA-R-297 (OMB# 0938-0787);                     *Use:*                     This form is needed to determine whether a beneficiary can enroll in Part B Medicare and/or qualify for premium reduction. This form is used by the Social Security Administration to obtain information from employers regarding whether a Medicare beneficiary's coverage under a group health plan is based on current employment.;                     *Frequency:*                     On occasion;                     *Affected Public:*                     Business or other for-profit;                     *Number of Respondents:*                     5,000;                     *Total Annual Responses:*                     5,000;                     *Total Annual Hours:*                     750.                 

                    To obtain copies of the supporting statement 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 and phone number, 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 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: June 5, 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. 01-14884 Filed 6-12-01; 8:45 am] 

BILLING CODE 4120-03-P