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

View RCF Information Collection (IC)

Federal IDR Process for Air Ambulance Services
 
Modified
 
Mandatory
 
29 CFR 2590

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Notice of Open Negotiation Yes Yes Fillable Printable
Other-Notice of IDR Initiation Yes Yes Fillable Printable
Other-Notice of Certified IDR Entity Selection Yes Yes Fillable Printable
Other-Notice of Agreement on an Out-of-Network Rate Yes Yes Fillable Printable
Other-Good Faith Estimate Template Notice Yes Yes Fillable Printable
Other- PPDR Data Elements for Patients and Providers Yes Yes Fillable Printable
Other-Vendor Management Data Elements Yes Yes Fillable Printable
Other-Payment Settlement Form Notice Yes Yes Fillable Printable
Other-Notice of Offer Data Elements Yes Yes Fillable Printable
Other-PPDR Dispute Initiation Form Yes Yes Fillable Printable
Other-Online PPDR Initiation Form Yes Yes Fillable Printable
Other-IDR Initiation Webform Yes Yes Fillable Fileable
Other-IDR Entity Selection Response Webform Yes Yes Fillable Fileable

Health Health Care Services

 

4,823,262 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 8,853,969 0 0 0 0 8,853,969
Annual IC Time Burden (Hours) 15,405,906 0 0 2,124,952 0 13,280,954
Annual IC Cost Burden (Dollars) 136,644,869 0 0 26,310,047 0 110,334,822

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.