Information Collection

Information Collection Requirements -- Pro Reconsiderations And Appeals 43 Cfr 473.18(a) And (b), 473.34(a) And (b) And 473.42(a)

IC 113739 under ICR 199306-0938-002 · OMB 0938-0443.

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Information Collection (IC) Details

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IC Title:	INFORMATION COLLECTION REQUIREMENTS -- PRO RECONSIDERATIONS AND APPEALS 43 CFR 473.18(A) AND (B), 473.34(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: 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	53	53
Annual IC Time Burden (Hours)	13,958	13,958
Annual IC Cost Burden (Dollars)	0	0

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