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Agenda
Reg Review
ICR
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