[Federal Register Volume 66, Number 44 (Tuesday, March 6, 2001)]
[Notices]
[Pages 13547-13548]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 01-5327]


-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[Document Identifier: HCFA-417]


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 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, 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: Hospice Request 
for Certification in the Medicare Program; Form No.: HCFA-417 (OMB 
# 0938-0313); Use: The Hospice Request for Certification Form is used 
for hospice identification, screening, and to initiate the 
certification process. The information captured on this form is entered 
into a data base which assists HCFA in determining whether providers 
have sufficient personnel to participate in the Medicare program; 
Frequency: Annually; Affected Public: Business or other for-profit, 
Not-for-profit institutions, Federal Government, and State, local or 
tribal government; Number of Respondents: 2,286; Total Annual 
Responses: 2,286; Total Annual Hours: 572.
    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 <a href="/cdn-cgi/l/email-protection#b7e7d6c7d2c5c0d8c5dcf7dfd4d1d699d0d8c1"><span class="__cf_email__" data-cfemail="0f5f6e7f6a7d78607d644f676c696e21686079">[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: Julie Brown, 
Attn.: HCFA 417, Room N2-14-26, 7500 Security Boulevard, Baltimore, 
Maryland 21244-1850.

    Dated: February 22, 2001.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA Office of Information Services, 
Information Technology Investment Management Group, Division of HCFA 
Enterprise Standards.
[FR Doc. 01-5327 Filed 3-5-01; 8:45 am]
BILLING COD

[[Page 13548]]

E 4120-03-M


</pre><script data-cfasync="false" src="/cdn-cgi/scripts/5c5dd728/cloudflare-static/email-decode.min.js"></script></body>
</html>