[Federal Register Volume 61, Number 174 (Friday, September 6, 1996)]
[Notices]
[Page 47131]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-22718]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[Document Identifier: HCFA-1964]


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. HCFA-1964 Type of Information Collection Request: Reinstatement, 
without change, of previously approved collection for which approval 
has expired; Title of Information Collection: Request for Review of 
Part B Medicare Claim and Supporting regulation 42 CFR 405.807; Form 
No.: HCFA-1964; Use: This form is completed by beneficiaries, 
representative, or assignees who wish to pursue their statutory appeal 
rights by requesting a review of an initial determination made by a 
Part B carrier on a claim for medical and other health services. 42 CFR 
405.807 is the regulation supporting this collection of information; 
Frequency: On occasion; Affected Public: Individuals or households, not 
for profit institutions; Number of Respondents: 7,200,000; Total Annual 
Responses: 7,200,000; Total Annual Hours: 1,800,000.
    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 P[email protected], 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: August 28, 1996.
Edwin J. Glatzel,
Director, Management Planning and Analysis Staff, Office of Financial 
and Human Resources, Health Care Financing Administration.
[FR Doc. 96-22718 Filed 9-5-96; 8:45 am]
BILLING CODE 4120-03-P