Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Deemed Compliance Reporting Unchanged 384 576 0
SBC Disclosure Modified 24211211 203564 10494154 Other-Maternity Care Narrative
Other-Diabetes 2 Narrative
Other-Uniform Glossary Anchor
Other-What the Plan Covers and What You Pay (No Answers)
Other-Why This Matters for SBC (Yes Answers)
Instruction
Instruction
Other-Completed SBC Template
Other-SBC Template
Other-Foot Fracture Narrative
Instruction
Other-Coverage Calculator
Other-Template
Other-Diabetes Guide
Other-Glossary Anchor
Other-Template
Instruction
Instruction
Other-Uniform Glossary
Form CMS-10407
Other-SBC Template - Carolinian
Other-Uniform Glossary - Carolinian
Other-Why This Matters NO Answers - Carolinian
Other-Why This Matters - Yes Answers - Carolinian
Other-SBC Template - Chamorro
Other-Uniform glossary - Chamorro
Other-Why This Matters No Answers - Chamorro
Other-Why This Matters YES Answers - Chamorro
Other-SBC Template - Chinese
Other-Uniform Glossary - Chinese
Other-Why This Matters NO Answers - Chinese
Other-Why This Matters Yes Answers - Chinese
Other-SBC Template - Pennsylvania Dutch
Other-Uniform Glossary - Pennsylvania Dutch
Other-Why This Matters No Answers - Pennsylvania Dutch
Other-Why This Matters YES Answers - Pennsylvania Dutch
Other-SBC Template - Samoan
Other-Uniform Glossary - Samoan
Other-Why This Matters No Answers - Samoan
Other-Why This Matters Yes Answers
Other-SBC Template - Spanish
Other-Uniform Glossary - Spanish
Other-Why This Matters No Answers - Spanish
Other-Why This Matters Yes Answers - Spanish
Other-Why This Matters Yes Answers - Spanish
Other-SBC Template - Tagalog
Other-Uniform Glossary - Tagalog
Other-Why This Matters No Answers - Tagalog
Other-Why This Matters Yes Answers - Tagalog
Other-SBC Template Standard Format - Navajo
Other-Why This Matters NO Answers - Navajo
Other-Why This Matters YES Answers - Navajo
Other-Uniform Glossary - Navajo
Total burden requested under this ICR: 24211595 204140 10494154  
To view an IC, click on IC Title