Information Collection

Medicare+Choice Appeal Notices, "Notice of Denial of Medical Coverage", "Notice of Denial of Payment" and supporting regulations in 42 CFR 422.568

IC 8626 under ICR 200403-0938-004 · OMB 0938-0829.

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Information Collection (IC) Details

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IC Title:	Medicare+Choice Appeal Notices, "Notice of Denial of Medical Coverage", "Notice of Denial of Payment" and supporting regulations in 42 CFR 422.568	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10003				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 211	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	71,200	41,308	29,892
Annual IC Time Burden (Hours)	7,120	4,126	2,994
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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