View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0938-0829	ICR Reference No: 200103-0938-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare+Choice Beneficiary Appeal Notices, "Notice of Denial of Medical Services", "Notice of Denial of Request for Payment" and Supporting Regulations in 42 CFR 422.568
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/22/2001
	Date Received in OIRA: 03/12/2001
Terms of Clearance: Approved for use through 5/2004 with the understanding that before initiating further EOB standardization, HCFA will brief OMB on the nature and prevalence of any beneficiary notification problems, as well as the anticipated benefits to patients and costs to M+C organizations of such an effort.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2004	05/31/2004
Responses	29,892	0	0
Time Burden (Hours)	2,994	0	0
Cost Burden (Dollars)	0	0	0

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