Information Collection Requirements in 42 CFR 478.36 - record of reconsideration

(CMS-R-72) Information Collection Requirements in 42 CFR Sections 478.18, 478.34, 478.36, and 478.42 QIO Reconsiderations and Appeals

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0443 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	Information Collection Requirements in 42 CFR 478.36 - record of reconsideration	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 478.36

Information Collection Instruments:

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20,129	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	20,129	19,829	300
Annual IC Time Burden (Hours)	1,677	1,477	200
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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