View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

2019 029 Noridian Feedback Survey_Enrollment (2) 30628 029
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 029 2019 029 Noridian Feedback Survey_Enrollment (2) 30628 2019 029 Noridian Feedback Survey_Enrollment (2) 30628.xlsx Yes Yes Fillable Fileable
Form and Instruction 029 Noridian Feedback Survey_MR AB 30628 Noridian Feedback Survey_MR AB 30628.xlsx Yes Yes Fillable Fileable
Form and Instruction 029 Noridian Feedback Survey_MR DME PA 30628 Noridian Feedback Survey_MR DME PA 30628.xlsx Yes Yes Fillable Fileable
Form and Instruction 029 Noridian Feedback Survey_MR DME TPE (1) 30628 Noridian Feedback Survey_MR DME TPE (1) 30628.xlsx Yes Yes Fillable Fileable
Form and Instruction 029 Noridian Feedback Survey_PCC 30628 Noridian Feedback Survey_PCC 30628.xlsx Yes Yes Fillable Fileable
Form and Instruction 029 Noridian Feedback Survey_POE Events 30628 Noridian Feedback Survey_POE Events 30628.xlsx Yes Yes Fillable Fileable
Form and Instruction 029 Noridian Feedback Survey_POE Page 30628 Noridian Feedback Survey_POE Page 30628.xlsx Yes Yes Fillable Fileable
Form and Instruction 029 Noridian Feedback Survey_Recoup 30628 Noridian Feedback Survey_Recoup 30628.xlsx Yes Yes Fillable Fileable
Form and Instruction 029 Noridian Feedback Survey_Redeter (1) 30628 Noridian Feedback Survey_Redeter (1) 30628.xlsx Yes Yes Fillable Fileable

General Government Central Records & Statistical Mgt

 

3,600 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 3,600 0 3,600 0 0 0
Annual IC Time Burden (Hours) 150 0 150 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
1090-0008 Generic Clearance Request Form_CMS Survey_IA 30628 Amend 4 1090-0008 Generic Clearance Request Form_CMS Survey_IA 30628 Amend 4.pdf 05/21/2019
Noridian Enrollment Feedback Survey 30628 Noridian Enrollment Feedback Survey 30628.docx 05/21/2019
Noridian Medical Review AB Feedback Survey 30628 Noridian Medical Review AB Feedback Survey 30628.docx 05/21/2019
Noridian Medical Review Prior Authorization Feedback Survey 30628 Noridian Medical Review Prior Authorization Feedback Survey 30628.docx 05/21/2019
Noridian Recoupment Feedback Survey 30628 Noridian Recoupment Feedback Survey 30628.docx 05/21/2019
Noridian Redeterminations Feedback Survey 30628 Noridian Redeterminations Feedback Survey 30628.docx 05/21/2019
Noridian Webpage Specific Feedback Survey 30628 Noridian Webpage Specific Feedback Survey 30628.docx 05/21/2019
Noridian Medical Review Targeted Probe & Educate DME Feedback Survey 30628 Noridian Medical Review Targeted Probe & Educate DME Feedback Survey 30628.docx 05/21/2019
Noridian Provider Contact Center Feedback Survey 30628 Noridian Provider Contact Center Feedback Survey 30628.docx 05/21/2019
Noridian Provider Outreach & Education Schedule of Events Feedback Survey 30628 Noridian Provider Outreach & Education Schedule of Events Feedback Survey 30628.docx 05/21/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.