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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Burden Estimates - Appeals
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
45 CFR 147.136
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Instruction
CMS-10338 Letter to Issuers.pdf
Yes
No
Fillable Fileable
Instruction
CMS-10338 Letter to Issuers in Territories.pdf
Yes
No
Fillable Fileable
Form and Instruction
CMS-10338
Adverse Benefit Determination Model Notice
CMS-10338 - Adverse Benefit Determination model notice.pdf
Yes
No
Fillable Fileable
Form and Instruction
CMS-10338
Internal Adverse Benefit Determination
CMS-10338 - Adverse Benefit Determination model notice.pdf
Yes
No
Fillable Fileable
Form and Instruction
CMS-10338
External Final Decision Model Notice
CMS-10338 - Final Internal Adverse Benefit Determination model notice.pdf
Yes
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
109,653
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
516,575,283
0
0
117,420,415
0
399,154,868
Annual IC Time Burden (Hours)
1,195,626
0
0
-507,191
0
1,702,817
Annual IC Cost Burden (Dollars)
149,806,832
0
0
34,092,590
0
115,714,242
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.