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

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

OMB: 0938-0778

IC ID: 46763

Information Collection (IC) Details

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Medicare Health Plan Appeals and Grievance Data Collection and Reporting Requirements, Data Disclosure Requirements under section 422.111
 
No Modified
 
Mandatory
 
42 CFR 422.111(c)(3)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction FORM INSTRUCTIONS CMS-R-0282_508 version-01-07-2010.docx Yes Yes Paper Only
Form CMS-R-0282 Medicare Appeals and Quality of Care Grievances CMS-R-0282 Sample Form508.pdf Yes Yes Paper Only

Health Health Care Services

 

629 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 45,917 0 0 3,819 0 42,098
Annual IC Time Burden (Hours) 3,673 0 0 305 0 3,368
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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