[Federal Register Volume 65, Number 107 (Friday, June 2, 2000)]
[Notices]
[Page 35379]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-13860]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[Document Identifier: HCFA-1965, HCFA-2649, HCFA-5011A & HCFA-5011B]


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 summary 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. 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 (0938-0034); 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 Responses: 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 (0938-0045); 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. Frequently: 
Annually, quarterly and monthly; Affected Public: Individuals or 
households, and not-for-profit institutions; Number of Respondents: 
62,000; Total Annual Responses: 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 
(0938-0486); 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 is 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 Responses: 
10,000; Total Annual Hours: 2,500.
    4. Type of Information Collection Request: Extension of a currently 
approved collection; Tital 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 
(0938-0567); 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 fail's 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 Responses: 
10,000; Total Annual Responses: 10,000; Total Annual Hours: 2,500.
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access HCFA's 
Web Site address at http://www.hcfa.gov/regs/prdact95.htm, or E-mail 
your request, including your address, phone number, OMB number, and 
HCFA document identifier, to [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 
Information Services, Security and Standards Group, Division of HCFA 
Enterprise Standards, Attention: Dawn Willinghan, Room N2-14-26, 7500 
Security Boulevard, Baltimore, Maryland 21244-1850.

    Dated: May 25, 2000.
John P. Burke, III,
HCFA Reports Clearance Officer, HCFA Office of Information Services, 
Security and Standards Group, Division of HCFA Enterprise Standards.
[FR Doc. 00-13860 Filed 6-1-00; 8:45 am]
BILLING CODE 4120-03-U