Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Claims Denial Disclosure under MHPAEA [Processed By Issuer or Third Party Service] [Electronic] Modified 329920 0 738195
Claims Denial Disclosure under MHPAEA [Processed By Issuer or Third Party Service] [Paper] Modified 109973 0 318647
Claims Denial Disclosure under MHPAEA [Processed In-House] [Electronic] Modified 17730 1478 0
Claims Denial Disclosure under MHPAEA [Processed In-House] [Paper] Modified 5910 493 0
Disclosure under MHPAEA [Processed By Issuer in the Individual Market] Modified 305581 25465 0
Medical Necessity Disclosure under MHPAEA [Processed In-House] [Electronic] Modified 1595 133 0
Medical Necessity Disclosure under MHPAEA [sent with Claims Denial Disclosure] [Processed In-House] [Electronic] Modified 1773 148 0
Medical Necessity Disclosure under MHPAEA [sent with Claims Denial Disclosure] [Processed In-House] [Paper] Modified 591 49 0
Medical Necessity Disclosure under MHPAEA [Processed By Issuer or Third Party Service] [Electronic] Modified 29688 0 66426
Medical Necessity Disclosure under MHPAEA [Processed By Issuer or Third Party Service] [Paper] Modified 48438 0 140348
Medical Necessity Disclosure under MHPAEA [Processed In-House] [Paper] Modified 2603 217 0
Medical Necessity Disclosure under MHPAEA [Sent with Claims Denial Disclosure] [Processed By Issuer or Third Party Service] [Electronic] Modified 32992 0 73820
Medical Necessity Disclosure under MHPAEA [Sent with Claims Denial Disclosure] [Processed By Issuer or Third Party Service] [Paper] New 10997 0 31865
Total burden requested under this ICR: 897791 27983 1369301  
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