Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Claims Denial Disclosure under MHPAEA Modified 669701 55809 0
Claims Denial Disclosure under MHPAEA [Processed By Issuer or Third Party Service] [Paper] Removed 0 0 0
Claims Denial Disclosure under MHPAEA [Processed In-House] [Electronic] Removed 0 0 0
Claims Denial Disclosure under MHPAEA [Processed In-House] [Paper] Removed 0 0 0
Disclosure Request Form Modified 167425 13952 0 Form and Instruction CMS-10307 Disclosure Request Form
Disclosure under MHPAEA [Processed By Issuer in the Individual Market] Removed 0 0 0
Medical Necessity Disclosure under MHPAEA Modified 83617 6968 0
Medical Necessity Disclosure under MHPAEA [Processed In-House] [Electronic] Removed 0 0 0
Medical Necessity Disclosure under MHPAEA [sent with Claims Denial Disclosure] [Processed In-House] [Electronic] Removed 0 0 0
Medical Necessity Disclosure under MHPAEA [sent with Claims Denial Disclosure] [Processed In-House] [Paper] Removed 0 0 0
Medical Necessity Disclosure under MHPAEA [Processed By Issuer or Third Party Service] [Electronic] Removed 0 0 0
Medical Necessity Disclosure under MHPAEA [Processed In-House] [Paper] Removed 0 0 0
Medical Necessity Disclosure under MHPAEA [Sent with Claims Denial Disclosure] [Processed By Issuer or Third Party Service] [Paper] Removed 0 0 0
Medical Necessity Disclosure under MHPAEA sent with Claims Denial Disclosure Modified 66970 5581 0
Total burden requested under this ICR: 987713 82310 0  
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