Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Claim In-Network or Out-of-Network Indicator Modified 650 2600 0
Respond to the final distributed data report Modified 650 3900 0 Other-Data Elements
Risk adjustment distributed data collection Modified 650 3771300 0 Other-Data Elements
Supplemental Diagnosis Modified 650 374400 0 Other-Data Elements
Upload of Risk Adjustment and Reinsurance Data for Masked Enrollee Identification Number Modified 650 1950 0 Other-Data Elements
Total burden requested under this ICR: 3250 4154150 0  
To view an IC, click on IC Title