Information Collection

Information Collection Requirements In 42 Cfr 473.18 (a) And (b), 473.34 (a) And (b), 47.36 (a) And (b) And 473.42 (a), Pro Reconsiderations And Appeals

IC 113737 under ICR 198808-0938-011 · OMB 0938-0443.

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Information Collection (IC) Details

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IC Title:	INFORMATION COLLECTION REQUIREMENTS IN 42 CFR 473.18 (A) AND (B), 473.34 (A) AND (B), 47.36 (A) AND (B) AND 473.42 (A), PRO RECONSIDERATIONS AND APPEALS	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	21,114	16,794	4,320
Annual IC Time Burden (Hours)	23,332	14,551	8,781
Annual IC Cost Burden (Dollars)	0	0	0

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