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Agenda
Reg Review
ICR
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]
Unchanged
329920
0
738195
Claims Denial Disclosure under MHPAEA [Processed By Issuer or Third Party Service] [Paper]
Unchanged
109973
0
318647
Claims Denial Disclosure under MHPAEA [Processed In-House] [Electronic]
Unchanged
17730
1478
0
Claims Denial Disclosure under MHPAEA [Processed In-House] [Paper]
Unchanged
5910
493
0
Disclosure Request Form
New
184733
15394
0
Form and Instruction
CMS-10307
Disclosure Request Form
Disclosure under MHPAEA [Processed By Issuer in the Individual Market]
Modified
304985
25415
0
Medical Necessity Disclosure under MHPAEA [Processed In-House] [Electronic]
Unchanged
1595
133
0
Medical Necessity Disclosure under MHPAEA [sent with Claims Denial Disclosure] [Processed In-House] [Electronic]
Unchanged
1773
148
0
Medical Necessity Disclosure under MHPAEA [sent with Claims Denial Disclosure] [Processed In-House] [Paper]
Unchanged
591
49
0
Medical Necessity Disclosure under MHPAEA [Processed By Issuer or Third Party Service] [Electronic]
Unchanged
29688
0
66426
Medical Necessity Disclosure under MHPAEA [Processed By Issuer or Third Party Service] [Paper]
Unchanged
48438
0
140348
Medical Necessity Disclosure under MHPAEA [Processed In-House] [Paper]
Unchanged
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]
Modified
10997
0
31865
Total burden requested under this ICR:
1081928
43327
1369301
To view an IC, click on IC Title