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View Information Collection (IC)

View Information Collection (IC)

Good Faith Estimates of Expected Charges Upon Request of Uninsured Individuals for Scheduled Items and Services
 
No Modified
 
Mandatory
 
45 CFR 149.610

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10791 Yes Yes Fillable Fileable

Health Health Care Services

 

511,748 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   10 %

  Requested 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 511,748 0 0 -2,987,194 3,498,942 0
Annual IC Time Burden (Hours) 755,658 0 0 -2,743,284 3,498,942 0
Annual IC Cost Burden (Dollars) 52,172,709 0 0 -304,544,428 356,717,137 0

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