[Federal Register Volume 62, Number 60 (Friday, March 28, 1997)]
[Notices]
[Pages 14918-14919]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-7892]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
(1965, 2649, 5011A-U6, 5011B-U6)
Agency Information Collection Activities: Proposed Collection;
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, is
publishing the following summary of proposed collections for public
comment. 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.
1. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Request for
Hearing--Part B Medicare Claim, 42 CFR 405.821; Form No.: HCFA-1965;
Use: Section 1869 of the Social Security Act authorizes a hearing for
any individual who is dissatisfied with any determination and amount of
benefit paid. This form is used so that a party may request a hearing
by a Hearing Officer because the review
[[Page 14919]]
determination failed to satisfy the appellant. Frequency: Annually,
Quarterly and Monthly; Affected Public: Individual or Households, and
Not for profit institutions; Number of Respondents: 55,000; Total
Annual Hours: 9,167.
2. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Request for
Reconsideration of Part A Insurance Benefits, 42 CFR 405.711; Form No.:
HCFA-2649; Use: Section 1869 of the Social Security Act authorizes a
hearing for any individual who is dissatisfied with the intermediary's
Part A determination or the amount paid. This form is used by a party
to request a reconsideration of the initial determination. Frequency:
Annually, Quarterly and Monthly; Affected Public: Individuals or
Households, and Not for profit institutions; Number of Respondents:
62,000; Total Annual Hours: 15,500.
3. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Request for Part
A Medicare Hearing by an Administrative Law Judge, 42 CFR 498.40; Form
No.: HCFA-5011A-U6; Use: Section 1869 of the Social Security Act
authorizes a hearing for any individual who is dissatisfied with the
intermediary's Part A determination or the amount paid. This form is
used by the beneficiary or other qualified appellant to request a
hearing by an Administrative Law Judge if the reconsideration
determination fails to satisfy the appellant. Frequency: Annually,
Quarterly and Monthly; Affected Public: Individuals or Households, and
Not for profit institutions; Number of Respondents: 10,000; Total
Annual Hours: 2,500.
4. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Request for Part
B Medicare Hearing by an Administrative Law Judge; Form No.: HCFA-
5011B-U6; Use: Section 1869 of the Social Security Act authorizes a
hearing for any individual who is dissatisfied with the carrier's Part
B determination or the amount paid. This form is used by the
beneficiary or other qualified appellant to request a hearing by an
Administrative Law Judge if the hearing officer's decision fails to
satisfy the appellant. Frequency: Annually, Quarterly and Monthly;
Affected Public: Individuals or Households, and Not for profit
institutions; Number of Respondents: 10,000; Total Annual Hours: 2,500.
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 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 Analysis and Planning Staff, Attention:
Louis Blank, Room C2-26-17, 7500 Security Boulevard, Baltimore,
Maryland 21244-1850.
Dated: March 19, 1997.
Edwin J. Glatzel,
Director, Management Analysis and Planning Staff, Office of Financial
and Human Resources.
[FR Doc. 97-7892 Filed 3-27-97; 8:45 am]
BILLING CODE 4120-03-P
