Federal Register / Vol. 61, No. 128 / Tuesday, July 2, 1996 / Notices 34437

subsistence expense ceiling for official travel

to Oshkosh (Winnebago County), Wisconsin,

due to the escalation of lodging rates during

the annual Experimental Aircraft Association

Convention and Show held there. This

special rate applies to claims for

reimbursement covering travel during the

period July 26 through August 10, 1996.

2. Background. The Federal Travel

Regulation (FTC) (41 CFR chapters 301–304)

part 301–8 permits the Administrator of

General Services to establish a higher

maximum daily rate for the reimbursement of

actual subsistence expenses of Federal

employees on official travel to an area within

the continental United States. The head of an

agency may request establishment of such a

rate when special or unusual circumstances

result in an extreme increase in subsistence

costs for a temporary period. The Secretary

of Transportation requested establishment of

such a rate for Oshkosh to accommodate

employees who perform temporary duty

there and experience a temporary but

significant increase in lodging costs due to

the escalation of lodging rates during the

annual Experimental Aircraft Association

Convention and Show. These circumstances

justify the need for higher subsistence

expense reimbursement in Oshkosh during

the designated period.

3. Maximum rate and effective date. The

Administrator of General Services, pursuant

to 41 CFR 301–8.3(c), has increased the

maximum daily amount of reimbursement

that may be approved for actual and

necessary subsistence expenses for official

travel to Oshkosh (Winnebago County),

Wisconsin for travel during the period July

27 through August 10, 1996. Agencies may

approve actual subsistence expense

reimbursement not to exceed $167 ($137

maximum for lodging and a $30 allowance

for meals and incidental expenses) for official

travel to Oshkosh (Winnebago County),

Wisconsin, during this time period.

4. Expiration date. This bulletin contains

information of a continuing nature as it

relates to the processing of travel

reimbursement claims and will remain in

effect until canceled.

5. For further information contact.

Devoanna R. Reels, General Services

Administration, Travel and Transportation

Management Policy Division (MTT),

Washington, DC 20405, telephone 202–501–

1538.

[FR Doc. 96–16798 Filed 7–1–96; 8:45 am]

BILLING CODE 6820–24–M

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

[HCFA–460]

Agency Information Collection

Activities: Submission for OMB

Review; 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, has submitted to the

Office of Management and Budget

(OMB) the following proposal for the

collection of information. 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: Medicare

Participating Physician or Supplier

Agreement, HCFA 460; Form No.: HCFA

460; Use: The HCFA 460 is completed

by nonparticipating physicians and

suppliers if they choose to participate in

Medicare Part B. By signing the

agreement, the physician or supplier

agrees to take assignment on all

Medicare claims. To take assignment

means to accept the Medicare allowed

amount as payment in full for the

services they furnish and to charge the

beneficiary no more than the deductible

and coinsurance for the covered service.

In exchange for signing the agreement,

the physician or supplier receives a

significant number of program benefits

not available to nonparticipating

physicians and suppliers. The

information is needed to know to whom

to provide these benefits. Frequency:

Once, unless re-enrolled; Affected

Public: Individuals or Households, and

Business or other for-profit; Number of

Respondents: 70,000; Total Annual

Responses: 70,000; Total Annual Hours

Requested: 17,500.

To request copies of the proposed

paperwork collections referenced above,

E-mail your request, including your

address, to Paperwork@hcfa.gov, or call

the Reports Clearance Office on (410)

786–1326. Written comments and

recommendations for the proposed

information collections should be sent

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, D.C. 20503.

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. 96–16843 Filed 7–01–96; 8:45 am]

BILLING CODE 4120–03–P

Agency Information Collection

Activities: Proposed Collection;

Comment Request

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 summaries 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.

1. Type of Information Collection

Request: Reinstatement, without change,

of previously approved collection for

which approval has expired; Title of

Information Collection: Information

Collection Requirements in 42 CFR

473.18 (a) and (b), 473.34 (a) and (b),

473.36 (a) and (b), and 473.42 (a), Peer

Review Organization (PRO)

Reconsideration and Appeals; Form No.:

HCFA–R–72; Use: These regulations

contain procedures for PRO’s to use in

reconsideration of initial

determinations. The information

requirements contained in these

regulations are on PROs to provide

information to parties requesting a

reconsideration review. These parties

will use the information as guidelines

for appeal rights in instances where

issues are still in dispute; Frequency:

On occasion; Affected Public: Business

or other for profit; Number of

Respondents: 53; Total Annual

Responses: 15,670; Total Annual Hours:

3,578.

2. Type of Information Collection

Request: Reinstatement, without change,

of previously approved collection for
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