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Monitoring and appeals process for survey vendors
No Modified
45 CFR 155.200(d) 45 CFR 156.1120-1125 45 CFR 156.200(b)(5) 45 CFR 156.1105

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10520 Vendor Appeal Form CMS-10520 - QHP Survey - Request for Appeal Form.docx Yes Yes Fillable Fileable

Health Health Care Services


14 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 14 0 -31 0 0 45
Annual IC Time Burden (Hours) 14 0 -31 0 0 45
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.