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Federal forms, ICRs, and supporting documents

OMB control number

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

OMB 0938-0443 · HHS/CMS.

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 Information Collection Requirements in 42 CFR Sections 478.18, 478.34, 478.36, and 478.42 QIO Reconsiderations and Appeals (CMS-R-72) expires 2029-07-31 and is listed under ICR 202511-0938-017.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
public comment.pdf (document unavailable)Public Comments
CMS-R-72 Response to 60 Day Public Comments.docxSupplementary Document
CMS-R-72 Supporting Statement 11-18-25.docxSupporting Statement A
Information Collection Requirements in 42 CFR 478.18(b) - Request for reconsideration Information collection
Information Collection Requirements in 42 CFR 478.42 - submitting a request for a hearing Information collection
Information Collection Requirements in 42 CFR 478.36 - record of reconsideration Information collection
Information Collection Requirements in 42 CFR 473.34(b) - reconsideration determination provider burden Information collection
Information Collection Requirements in 42 CFR 478.34(a) - Notice of a reconsidered determination Information collection

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202511-0938-017 Reinstatement without change of a previously approved collection 2025-11-26
202112-0938-004 Extension without change of a currently approved collection 2021-12-07 Approved without change
201804-0938-028 Extension without change of a currently approved collection 2018-04-30 Approved without change
201609-0938-027 Extension without change of a currently approved collection 2016-09-29 Approved without change
201609-0938-016 Extension without change of a currently approved collection 2016-09-27 Improperly submitted and continue
201308-0938-017 Reinstatement without change of a previously approved collection 2013-08-15 Approved without change
200912-0938-002 Reinstatement without change of a previously approved collection 2009-12-02 Approved without change
200607-0938-004 Extension without change of a currently approved collection 2006-07-06 Approved without change
200303-0938-011 Extension without change of a currently approved collection 2003-03-25 Approved with change
199911-0938-001 Extension without change of a currently approved collection 1999-11-04 Approved without change
199610-0938-002 Reinstatement without change of a previously approved collection 1996-10-02 Approved without change
199306-0938-002 Reinstatement with change of a previously approved collection 1993-06-28 Approved without change
198912-0938-001 Revision of a currently approved collection 1989-12-08 Approved without change
198808-0938-011 Revision of a currently approved collection 1988-08-23 Approved without change
198507-0938-002 New collection (Request for a new OMB Control Number) 1985-07-31 Approved without change

OMB Details

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

Federal Enterprise Architecture: Health - Health Care Services