Information Collection

Unform Exceptions and Appeals

IC 195403 under ICR 201011-0938-011 · OMB 0938-1338.

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IC Title:

Unform Exceptions and Appeals

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 423.562 42 CFR 423.128

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,273

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 4 %

table that charts list of burden
	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	2,834,898	2,834,898
Annual IC Time Burden (Hours)	259,687	259,687
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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