[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 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 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