Information Collection

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

IC 113738 under ICR 198912-0938-001 · OMB 0938-0443.

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Information Collection (IC) Details

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IC Title:	PRO RECONSIDERATIONS AND APPEALS IN 42 CFR 473.18 (A) AND (B), 473.34 (A) AND (B), 47.36 (A) AND (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: 53	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	53,523	32,409	21,114
Annual IC Time Burden (Hours)	64,404	41,072	23,332
Annual IC Cost Burden (Dollars)	0	0	0

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