Information Collection

Request for Reconsideration of Part A Insurance Benefits and Supporting Regulations in 42 CFR 405.711

IC 7799 under ICR 199706-0938-002 · OMB 0938-0045.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0045 can be found here:

Documents and Forms

Document Name Document Type

No indexed documents/forms are available for this IC yet. A refresh has been queued.

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Reconsideration of Part A Insurance Benefits and Supporting Regulations in 42 CFR 405.711	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	HCAF-2649				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 62,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	62,000	62,000
Annual IC Time Burden (Hours)	15,500	15,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

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