[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 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 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