34438 Federal Register / Vol. 61, No. 128 / Tuesday, July 2, 1996 / Notices

which approval has expired; Title of

Information Collection: Request for

Enrollment in Supplementary Medical

Insurance; Form No.: HCFA–4040; Use:

The HCFA–4040 is used to establish

entitlement to Supplementary Medical

Insurance by Beneficiaries not eligible

under Part A of Title XVIII or Title II of

the Social Security Act. The HCFA–

4040SP is the Spanish edition of this

form; Frequency: One time only;

Affected Public: Individuals and

households, Federal government, State,

local, or tribal governments; Number of

Respondents: 10,000; Total Annual

Responses: 10,000; Total Annual Hours:

2,500.

3. Type of Information Collection

Request: Extension of a currently

approved collection; Title of

Information Collection: Request for

Certification as a Rural Health Clinic,

Rural Health Clinic Survey Report

Form; Form No.: HCFA–29, 30; Use: The

form HCFA–29 ‘‘Request for

Certification as a Rural Health Clinics’’

is used by facilities to apply to

participate in the Medicare program.

The form HCFA–30 ‘‘Rural Health

Clinic Survey Report Form, is used by

State survey agencies to record data

needed to determine compliance with

the Federal requirements; Frequency:

Annually; Affected Public: State, local

or tribal governments; Number of

Respondents: 390; Total Annual

Responses: 390; Total Annual Hours:

682.

4. Type of Information Collection

Request: Reinstatement, without change,

of previously approved collection for

which approval has expired; Title of

Information Collection: Quarterly

Showing; Form No.: HCFA–R–41; Use:

This form is used by State Medicaid

agencies to list participating health care

facilities and the dates the State

agencies reviewed the facilities. The

lists are required to assure the existence

of an effective utilization (of services)

control program, as required by law and

regulation, to avoid a penalty;

Frequency: Quarterly; Affected Public:

State, local or tribal governments;

Number of Respondents: 47; Total

Annual Responses: 188; Total Annual

Hours: 9,212.

5. Type of Information Collection

Request: Reinstatement, without change,

of previously approved collection for

which approval has expired; Title of

Information Collection: Quarterly

Showing Validation Survey; Form No.:

HCFA–9050; Use: Reporting entities

may be required to submit lists of

Medicaid beneficiaries residing in a

select number of institutions. State

Medicaid agencies may also be required

to submit procedures for conducting

inspection of care reviews and other

documentation necessary to validate the

Quarterly Showing reports. The listings

are required to determine those patients

for which the State is currently

responsible for their care. This part of

the operation to determine that states

have an effective utilization control

program; Frequency: Annually; Affected

Public: State, local or tribal

governments; Number of Respondents:

47; Total Annual Responses: 8; Total

Annual Hours: 376.

6. Type of Information Collection

Request: Reinstatement, with change, of

previously approved collection for

which approval has expired; Title of

Information Collection: Medicare

Managed Care Disenrollment Form;

Form No.: HCFA–566; Use: This form is

used to process a beneficiaries request

of disenrollment action from a health

maintenance organization or

competitive medical plan and to update

the beneficiaries’ health insurance

master record; Frequency: On occasion;

Affected Public: Individuals and

households, Business or other for profit,

not for profit institutions, Federal

government, State, local, or tribal

governments; Number of Respondents:

24,000; Total Annual Responses:

24,000; Total Annual Hours: 792.

7. Type of Information Collection

Request: New collection; Title of

Information Collection: ‘‘Maximizing

the Effective Use of Telemedicine: A

study of the Effects, Cost Effectiveness

and Utilization Patterns of

Consultations via Telemedicine.’’; Form

No.: HCFA–R–197; Use: The major

objective of this study is to evaluate the

medical and cost effectiveness of three

different categories of telemedicine

services; Frequency: Other

(periodically); Affected Public:

Individuals and households, Business or

other for profit, not for profit

institutions; Number of Respondents:

1819; Total Annual Responses: 11,095;

Total Annual Hours: 1,564.

8. Type of Information Collection

Request: Revision of a currently

approved collection; Title of

Information Collection: Business

Proposal Formats for Utilization and

Quality Control Peer Review

Organizations (PROs); Form No.: HCFA–

718–721; Use: Submission of proposal

information by current PROs and other

bidders, according to the business

proposal instructions, will satisfy

HCFA’s need for consistent, and

verifiable data with which to validate

contract proposals; Frequency: Other

(Tri-annually); Affected Public: Business

or other for profit, not for profit

institutions; Number of Respondents:

20; Total Annual Responses: 23; Total

Annual Hours: 450.

9. Type of Information Collection

Request: Reinstatement, without change,

of a previously approved collection for

which approval has expired; Title of

Information Collection: Request for

Accelerated Payments; Form No.:

HCFA–9042; Use: These forms are used

by fiscal intermediaries to access a

provider’s eligibility for accelerated

payments. Such payment is granted if

there is an unusual delay in processing

bills. Frequency: On occasion; Affected

Public: Business or other for-profit and

Not for-profit institutions; Number of

Respondents: 854; Total Annual

Responses: 854; Total Annual Hours

Requested: 427.

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 , or to obtain the

supporting statement and any related

forms, 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 60 days of this notice directly to

the HCFA Paperwork Clearance Officer

designated at the following address:

HCFA, Office of Financial and Human

Resources, Management Planning and

Analysis Staff, Attention: John Burke,

Room C2–26–17, 7500 Security

Boulevard, Baltimore, Maryland 21244–

1850.

Dated: June 25, 1996.

Kathleen B. Larson,

Director, Management Planning and Analysis

Staff, Office of Financial and Human

Resources, Health Care Financing

Administration.

[FR Doc. 96–16844 Filed 7–1–96; 8:45 am]

BILLING CODE 4120–03–P

Substance Abuse and Mental Health

Services Administration

Agency Information Collection

Activities: Proposed Collection;

Comment Request

In compliance with section

3506(c)(2)(A) of the Paperwork

Reduction Act of 1995 for opportunity

for public comment on proposed data

collection projects, the Substance Abuse

and Mental Health Services

Administration will publish periodic

summaries of proposed projects. To

request more information on the

proposed projects or to obtain a copy of

the data collection plans and
Federal Register / Vol. 61, No. 128 / Tuesday, July 2, 1996 / Notices 34439

instruments, call the SAMHSA Reports

Clearance Officer on (301) 443–0525.

Comments are invited on: (a) Whether

the proposed collection of information

is necessary for the proper performance

of the functions of the agency, including

whether the information shall have

practical utility; (b) the accuracy of the

agency’s estimate of the burden of the

proposed collection of information; 

ways to enhance the quality, utility, and

clarity of the information to be

collected; and (d) ways to minimize the

burden of the collection of information

on respondents, including through the

use of automated collection techniques

or other forms of information

technology.

Proposed Project: Evaluation of Model

Programs Targeting Substance Abusing

Pregnant and Postpartum Women and

their Infants —Revision—Data are

collected from clients, comparison

group women, and staff on interventions

received and maternal and child

outcomes as part of an evaluation of

model projects serving substance

abusing pregnant and postpartum

women and their infants. The model

projects are funded by the Center for

Substance Abuse Prevention, SAMHSA.

This evaluation will assist CSAP in

accomplishing national health

objectives related to maternal and child

health, especially those directly related

to maternal substance abuse and its

potential effects on birth outcomes and

child development. In this proposed

revision of an ongoing study, the data

collection instruments remain

unchanged. Sample sizes are somewhat

smaller than originally anticipated

resulting in a reduced annual burden.

The estimated revised burden is shown

below.

Number

of respondents

Responses

per respondent

Hours per

response

Total burden

hours

823 5.48 0.24 1082

Send comments to Deborah Trunzo,

SAMHSA Reports Clearance Officer,

Room 16–105, Parklawn Building, 5600

Fishers Lane, Rockville, MD 20857.

Written comments should be received

within 60 days of this notice.

Dated: June 25, 1996.

Richard Kopanda

Executive Officer, Substance Abuse and

Mental Health Services Administration.

[FR Doc. 96–16831 Filed 7–01–96; 8:45 am]

BILLING CODE 4162–20–P

DEPARTMENT OF HOUSING AND

URBAN DEVELOPMENT

[Docket No. FR–4100–N–01]

Office of the Assistant Secretary for

Housing—Federal Housing

Commissioner; Notice of Proposed

Information Collection for Public

Comment

AGENCY: Office of the Assistant

Secretary for Housing-Federal Housing

Commissioner, HUD.

ACTION: Notice.

SUMMARY: The proposed information

collection requirement described below

will be submitted to the Office of

Management and Budget (OMB) for

review, as required by the Paperwork

Reduction Act. The Department is

soliciting public comments on the

subject proposal.

DATES: Comments due: September 3,

1996.

ADDRESSES: Interested persons are

invited to submit comments regarding

this proposal. Comments should refer to

the proposal by name and/or OMB

Control Number and should be sent to:

Oliver Walker, Housing, Department of

Housing and Urban Development, 451–

7th Street SW., Room 9116, Washington,

DC 20410.

FOR FURTHER INFORMATION CONTACT:

Ann M. Sudduth, Telephone number

(202) 708–0740 (this is not a toll-free

number) for copies of the proposed

forms and other available documents.

SUPPLEMENTARY INFORMATION: The

Department will submit the proposed

information collection to OMB for

review, as required by the Paperwork

Reduction Act of 1995 (44 U.S.C.

Chapter 35, as amended).

The Notice is soliciting comments

from members of the public and

affecting agencies concerning the

proposed collection of information to:

(1) Evaluate whether the proposed

collection of information is necessary

for the proper performance of the

functions of the agency, including

whether the information will have

practical utility; (2) Evaluate the

accuracy of the agency’s estimate of the

burden of the proposed collection of

information; (3) Enhance the quality,

utility, and clarity of the information to

be collected; and (4) Minimize the

burden of the collection of information

on those who are to respond; including

through the use of appropriate

automated collection techniques or

other forms of information technology,

e.g., permitting electronic submission of

responses.

This Notice also lists the following

information:

Title of Proposal: Request for

Occupied Conveyance.

OMB Control Number: 2502–0268.

Description of the need for the

information and the proposed use:

Information collected by this form

provides information HUD needs to

determine if the occupant is financially

able to pay the fair market rent and/or

whether a member of the immediate

family residing in the residence suffers

from a temporary, permanent or longterm illness or injury which would be

aggravated by the process of moving.

HUD field office personnel use this

information to base its determination as

whether to approve or deny occupied

conveyance.

Agency form numbers: HUD–9539.

Members of affected public:

Individuals or households.

An estimation of the total numbers of

hours needed to prepare the information

collection is 17,387.50, number of

respondents is 11,025, frequency

response is one-time, and the hours of

response is 4,012.50.

Status of the proposed information

collection: Extension of a currently

approved collection.

Authority: Section 3506 of the Paperwork

Reduction Act of 1995, 44 U.S.C. Chapter 35,

as amended.

Dated: June 21, 1996.

Nicolas P. Retsinas,

Assistant Secretary for Housing—Federal

Housing Commissioner.

[FR Doc. 96–16789 Filed 7–1–96; 8:45 am]

BILLING CODE 4210–27–M

DEPARTMENT OF THE INTERIOR

Office of the Secretary

National Environmental Policy Act:

Implementing Procedures (516 DM 6,

Appendix 9)

AGENCY: Department of the Interior.

ACTION: Notice of a proposed addition to

the Department of the Interior’s

Categorical Exclusions for the Bureau of

Reclamation.

SUMMARY: This notice announces a

proposed addition to the categorical

exclusions included in Departmental

Manual 516 DM 6, appendix 9, that lists

actions excluded from the National

Environmental Policy Act of 1969

(NEPA) procedures for the Bureau of

Reclamation (Reclamation). The

proposed categorical exclusion pertains

to transfer of title to single-purpose

facilities within Reclamation projects to

non-Federal entities.