Information Collection

Information Collection Requirements in 42 CFR 473.18, 473.34, 473.36, and 473.42, PRO Reconsideration and Appeals

IC 8048 under ICR 199911-0938-001 · 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, 473.34, 473.36, and 473.42, PRO Reconsideration 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: 53	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	15,670	15,670
Annual IC Time Burden (Hours)	3,578	3,578
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.