Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Federal IDR Process for Air Ambulance Services New 4497 6549 17003 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 13743 26422 60162 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 85 0 22135 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 13 3 0 Other-Request of Extension of Time Periods for Extenuating Circumstances
Total burden requested under this ICR: 18338 32974 99300  
To view an IC, click on IC Title