Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Federal IDR Process for Air Ambulance Services New 8853969 12894072 33476548 Other-Notice of Open Negotiation
Other-Notice of IDR Initiation
Other-Notice of Certified IDR Entity Selection
Other-Notice of Agreement on an Out-of-Network Rate
Other-Notice of Offer
Federal IDR Process for Services relating to Nonparticipating Providers or Nonparticipating Emergency Facilities New 1 2 4 Other-Notice of Open Negotiation
Other-Notice of IDR Initiation
Other-Notice of Certified IDR Entity Selection
Other- Notice of Agreement on an Out-of-Network Rate
Other-Notice of Offer
IDR Entity Certification and IDR Entity Monthly Reporting New 1 0 260 Other-IDR Certification Application
Other-Notice of Petition for Denial or Revocation
Other-Monthly IDR Entity Reporting Requirements
Other-Notice of IDR Payment Determination
Request of Extension of Time Periods for Extenuating Circumstances New 1 0 0 Other-Request of Extension of Time Periods for Extenuating Circumstances
Total burden requested under this ICR: 8853972 12894074 33476812  
To view an IC, click on IC Title