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

OMB 0938-0443

These regulations contain procedures for QIOs (formerly known as PROs) to use in reconsideration of initial determinations. The information requirements contained in these regulations are on QIOs to provide information to parties requesting a reconsideration. These parties will use the information as guidelines for appeal rights in instances where issues are still in dispute.

The latest form for (CMS-R-72) Information Collection Requirements in 42 CFR Sections 478.18, 478.34, 478.36, and 478.42 QIO Reconsiderations and Appeals expires 2021-12-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
CMS-R-72 Supporting Statemen_09142021.docx Supporting Statement A
Information Collection Requirements in 42 CFR 478.18(b) - Request for reconsideration
Information Collection Requirements in 42 CFR 478.42 - submitting a request for a hearing
Information Collection Requirements in 42 CFR 478.36 - record of reconsideration
Information Collection Requirements in 42 CFR 473.34(b) - reconsideration determination provider burden
Information Collection Requirements in 42 CFR 478.34(a) - Notice of a reconsidered determination

All Historical Document Collections

202112-0938-004 Approved without change	Extension without change of a currently approved collection	2021-12-07
201804-0938-028 Approved without change	Extension without change of a currently approved collection	2018-04-30
201609-0938-027 Approved without change	Extension without change of a currently approved collection	2016-09-29
201609-0938-016 Improperly submitted and continue	Extension without change of a currently approved collection	2016-09-27
201308-0938-017 Approved without change	Reinstatement without change of a previously approved collection	2013-08-15
200912-0938-002 Approved without change	Reinstatement without change of a previously approved collection	2009-12-02
200607-0938-004 Approved without change	Extension without change of a currently approved collection	2006-07-06
200303-0938-011 Approved with change	Extension without change of a currently approved collection	2003-03-25
199911-0938-001 Approved without change	Extension without change of a currently approved collection	1999-11-04
199610-0938-002 Approved without change	Reinstatement without change of a previously approved collection	1996-10-02
199306-0938-002 Approved without change	Reinstatement with change of a previously approved collection	1993-06-28
198912-0938-001 Approved without change	Revision of a currently approved collection	1989-12-08
198808-0938-011 Approved without change	Revision of a currently approved collection	1988-08-23
198507-0938-002 Approved without change	New collection (Request for a new OMB Control Number)	1985-07-31

OMB Details

Information Collection Requirements in 42 CFR 478.18(b) - Request for reconsideration

Federal Enterprise Architecture: Health - Health Care Services