ICR Documents

Supporting Statement A Document Date Uploaded Supptg Stmt A.doc 09/03/2015 Supporting Statement B Document Date Uploaded Supporting Statement B.docx 09/03/2015 Supplementary Documents Title Document Document Type Date Uploaded Authorizing Legislation Appendix A Legislation.docx Supplementary Document 12/18/2014 Published 60 Day FRN Appendix B 60dy FRN.pdf Supplementary Document 12/18/2014 IRB Appendix K IRB.pdf Supplementary Document 12/18/2014 Public Comments to 60 Day FRN Appendix J Public comments.docx Supplementary Document 12/30/2014 Response to Public Comment Appendix Y Response to Public Comments.docx Supplementary Document 09/04/2015 Enrollment Denial Letter to Respondent Appendix U Enrollment Denial Letter and Appeal Notification.docx Supplementary Document 09/04/2015 Denial Letter Appendix V Enrollment Denial Letter and Appeal Notification.docx Supplementary Document 09/04/2015 Treatment Denial Letter to Respondent Appendix W Treatment Denial Letter and Appeal Notification.docx Supplementary Document 09/04/2015 HSRB Letter Appendix Z HSRB.pdf Supplementary Document 09/04/2015 PA 3 Dental Appendix Q PA3 Standard_Final.pdf Supplementary Document 09/04/2015 PA3 Dental Appendix R PA3_Dental_Final.pdf Supplementary Document 09/04/2015 PA 3 Transplant Appendix S PA3 Transplant_Final.pdf Supplementary Document 09/04/2015 Prior Authorization Appendix T Pharmacy Prior Authorization_Final.pdf Supplementary Document 09/04/2015 WTC 5 Appendix O WTC_5_Final.pdf Supplementary Document 09/04/2015 WTC 6 Appendix P WTC_6_Final.pdf Supplementary Document 09/04/2015 Public Comments Author Name Comment Document Author Affiliation Sponsoring Org. Type Category Date of Comment Date Comment Received