[Federal Register Volume 65, Number 185 (Friday, September 22, 2000)]
[Notices]
[Pages 57356-57357]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 00-24344]


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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: 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

[[Page 57357]]

(HCFA), Department of Health and Human Services, has submitted to the 
Office of Management and Budget (OMB) the following proposal 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. 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. Frequency: 
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 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 Responses: 
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 
(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 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.
    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 E-mail your request, 
including your address and phone number, 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 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: August 3, 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. 00-24344 Filed 9-21-00; 8:45 am]
BILLING CODE 4120-03-P