[Federal Register Volume 62, Number 111 (Tuesday, June 10, 1997)]
[Notices]
[Pages 31613-31614]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-15027]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[1965, 2649, 5011A, 5011B and 9049]
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
proposals 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.
[[Page 31614]]
1. Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Request for
Hearing--Part B Medicare Claim and Supporting Regulations in 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
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 and Supporting Regulations
in 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
benefit amount paid. This form is used by a party to request a
reconsideration of the initial determination of benefits. 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 and Supporting
Regulations in 42 CFR 498 Subpart D and E; 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 and Supporting
Regulations in 42 CFR 498 Subpart D and E; 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.
5. Type of Information Collection Request: Reinstatement, with
change, of a previously approved collection for which approval has
expired; Title of Information Collection: Information on Provider
Refunds and Supporting Regulations in 42 CFR 489.40-41; Document No.:
HCFA-9049; Use: When a Medicare claim is denied and then paid as a
result of a reconsideration, there is a possibility that the provider
has already been paid by the beneficiary. These questions on provider
refunds will be used on intermediary forms to verify that the provider
has refunded the beneficiary's money. Frequency: On occasion; Affected
Public: Business or other for-profit; Number of Respondents: 4,236;
Total Annual Hours: 1,059.
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 30 days of this notice directly to the HCFA Paperwork Clearance
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 3, 1997.
Edwin J. Glatzel,
Director, Management Analysis and Planning Staff, Office of Financial
and Human Resources, Health Care Financing Administration.
[FR Doc. 97-15027 Filed 6-9-97; 8:45 am]
BILLING CODE 4120-03-P
