Information Collection

Information Collection Requirements In Hsq-111-f, Pro Reconsiderations & Appeals, 42 Cfr 473.18(a) & (b), 473.34 (a) & (b), 473.36(a) & (b) And 473.42(a)

IC 113736 under ICR 198507-0938-002 · OMB 0938-0443.

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Information Collection (IC) Details

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IC Title:	INFORMATION COLLECTION REQUIREMENTS IN HSQ-111-F, PRO RECONSIDERATIONS & APPEALS, 42 CFR 473.18(A) & (B), 473.34 (A) & (B), 473.36(A) & (B) AND 473.42(A)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCFA-R-72				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,320	4,320
Annual IC Time Burden (Hours)	8,781	8,781
Annual IC Cost Burden (Dollars)	0	0

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Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.