[Federal Register Volume 65, Number 111 (Thursday, June 8, 2000)]
[Notices]
[Pages 36453-36454]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-14451]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

[Document Identifier: HCFA-10003]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Health Care Financing Administration.
    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.
    Type of Information Collection Request: New Collection.
    Title of Information Collection: Medicare + Choice Beneficiary 
Appeal Notices, ``Notices of Denial of Medical Services,'' ``Notice of 
Denial of Request for Payment'' and Supporting Regulations in 42 CFR 
422.568.
    Form No.: HCFA-10003 (OMB# 0938-NEW).
    Use: This collection includes two Medicare + Choice appeal notices, 
Denial of Service and Denial of Payment. Pursuant to the Social 
Security Act Section 1852(g)(1)(B), M+C organizations are required to 
issue notices to Medicare managed care beneficiaries when a request for 
either medical service or payment is denied. Additionally, the notices 
inform beneficiaries of their right to file an appeal.
    All M+C organizations will be required to use these forms. Neither 
the Health Care Financing Administration (HCFA) nor the M+C 
organizations will use such notices to collect and analyze data on M+C 
beneficiary appeals. They are for information purposes only.
    Frequency: On occasion.
    Affected Public: Business or other for-profit and Individuals or 
Households.
    Number of Respondents: 29,892.
    Total Annual Responses: 29,892.
    Total Annual Hours: 2,994.
    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.


[[Page 36454]]


    Dated: May 30, 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. 00-14451 Filed 6-07-00; 8:45 am]
BILLING CODE 4120-03-M