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Information Collection

Medicare Health Plan Appeals and Grievance Data Collection and Reporting Requirements, Data Disclosure Requirements under section 422.111

IC 8532 under ICR 200701-0938-013 · OMB 0938-0778.

Documents and Forms
Document Name
Document Type
Instruction
Other-Other
Form
Information Collection (IC) Details

View Information Collection (IC)

Medicare Health Plan Appeals and Grievance Data Collection and Reporting Requirements, Data Disclosure Requirements under section 422.111
 
No Modified
 
Mandatory
 
42 CFR 422.422.111

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction CMS-R-0282 FORM INSTRUCTIONS CMS-R-0282.doc Yes Yes Paper Only
Other-Other CMS-R-0282 Disclosure Statement.doc Yes Yes Paper Only
Form CMS-R-0282 Medicare Appeals and Quality of Care Grievances Sample Report CMS-R-0282 Sample Form.doc Yes Yes Paper Only

Health Health Care Services

 

434 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 868 0 0 252 0 616
Annual IC Time Burden (Hours) 868 0 0 430 0 438
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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