Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Essential Community Provider and Network Adequacy Data Requirements Modified 164 3280 142245 Form and Instruction CMS-10803
Other-Screenshots
Form CMS-10803
QHP Issuers for the Appointment Wait Time Secret Shopper Data Collection Modified 155 6510 0
Stand-Alone Dental Issuers for NA Template and ECP Data Collection New 157 628 0
Third Party Survey Vendors New 155 215760 0
Total burden requested under this ICR: 631 226178 142245  
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