Information Collection

REG-125592-10, Patient Protection and Affordable Care Act Internal Claims and Appeals and External review Disclosures.

IC 193852 under ICR 201008-1545-026 · OMB 1545-2182.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-2182 can be found here:

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Information Collection (IC) Details

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IC Title:	REG-125592-10, Patient Protection and Affordable Care Act Internal Claims and Appeals and External review Disclosures.	Agency IC Tracking Number:	ah-XXXX-049

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 26 CFR 54.9815-2719T

Information Collection Instruments:

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

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 607,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	62,000	62,000
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

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