Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
of Denial of Medical Coverage (NDMC), and the Notice of Denial of Payment (NDP) - 42 CFR 422.568 (CMS-10003) Modified 105138 26285 0 Form CMS-10003
Form CMS-10003 NDP
Instruction
Instruction
Total burden requested under this ICR: 105138 26285 0  
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