[Federal Register Volume 61, Number 230 (Wednesday, November 27, 1996)]
[Notices]
[Pages 60290-60291]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-30224]


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


Agency Information Collection Activities: Submission for OMB 
Review; Comment Request

AGENCY: Health Care Financing Administration, HHS.
    In compliance with the Paperwork Reduction Act of 1995 (44 U.S.C. 
3501 et seq.), 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.
    1. HCFA-1964 Type of information collection request: Reinstatement, 
without change, of previously approved collection for which approval 
has

[[Page 60291]]

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 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 should be sent 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, D.C. 20503.

    Dated: November 19, 1996.
Edwin J. Glatzel,
Director, Management Analysis and Planning Staff, Office of Financial 
and Human Resources, Health Care Financing Administration.
[FR Doc. 96-30224 Filed 11-26-96; 8:45 am]
BILLING CODE 4120-03-P