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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
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
To view an IC, click on IC Title