Information Collection Request

Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non-grandfathered Group Health Plans and Issuers and Individual Market Issuers

ICR 201106-0938-021 · OMB 0938-1099 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10338 States With External Review Laws - 2013 Form and Instruction Removed Available
Form CMS-10338 States With External Review Laws - 2012 Form and Instruction Removed Available
Form CMS-10338 States With External Review Laws - 2011 Form and Instruction Removed Repair queued
Form CMS-10338 States With No External Review Laws - 2013 Form and Instruction Removed Available
Form CMS-10338 States With No External Review Laws - 2012 Form and Instruction Removed Repair queued
Form CMS-10338 States With No External Review Laws - 2011 Form and Instruction Removed Available
CMS-9993-IFC2 (76FR37208)-6-24-11.pdf Supplementary Document Uploaded 2011-09-01 Available
CMS-10338.CLAS Bulletin.pdf Supplementary Document Uploaded 2011-06-22 Available
CMS-10338.HHS SRG on Elections.pdf Supplementary Document Uploaded 2011-06-22 Available
CMS-10338.Technical Release and Model Notices.pdf Supplementary Document Uploaded 2011-06-22 Available
CMS-10338.Emergency Justification Appeals PRA.docx Supplementary Document Uploaded 2011-06-22 Available
CMS-10338 Supporting Statement Update Clean 10-18.docx Supporting Statement A Uploaded 2011-11-09 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
194657 States With External Review Laws - 2013 Form and Instruction Removed
194656 States With External Review Laws - 2012 Form and Instruction Removed
194655 States With External Review Laws - 2011 Form and Instruction Removed
194345 States With No External Review Laws - 2013 Form and Instruction Removed
194344 States With No External Review Laws - 2012 Form and Instruction Removed
194343 States With No External Review Laws - 2011 Form and Instruction Removed
193862 Recordkeeping Requirements Removed
193861 Disclosures and Review Burden (2011-2013) Instruction Modified
193860 Disclosure for 2012 Removed
193859 Disclosures for 2011 Removed

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2012 6 Months From Approved 11/30/2011
70,834,597 0 211,216,845
930,267 0 2,762,824
36,775,067 0 109,200,000





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 70,834,597 211,216,845 0 -140,814,845 432,597 0
Annual Time Burden (Hours) 930,267 2,762,824 0 -1,562,824 -269,733 0
Annual Cost Burden (Dollars) 36,775,067 109,200,000 0 -58,100,000 -14,324,933 0


Reginfo record details
  No