In compliance with the requirement of section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995, the Centers for Medicare and Medicaid Services (CMS), 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: The Financial Statement of Debtor and Supporting Regulations in 42 CFR, Section 405.376;
Form No.: HCFA-379 (OMB# 0938-0270);
Use: This form is used to collect financial information which is needed to evaluate requests from physicians/suppliers to pay indebtedness under an extended repayment schedule, or to compromise a debt less than the full amount.;
Frequency: Other: As needed;
Affected Public: Business or other for-profit, and individuals or households;
Number of Respondents: 500;
Total Annual Responses: 500;
Total Annual Hours: 1,000.
To obtain copies of the supporting statement for the proposed paperwork collections referenced above, access CMS'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.Start Signature
Dated: July 13, 2001.
John P. Burke III,
CMS Reports Clearance Officer, CMS, Office of Information Services,Security and Standards Group, Division of CMS Enterprise Standards.
[FR Doc. 01-19939 Filed 8-8-01; 8:45 am]
BILLING CODE 4120-03-P