Information Collection

Collection of Encounter Data from Medicare Advantage Organizations

IC 199936 under ICR 201110-0938-012 · OMB 0938-1152.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1152 can be found here:

Documents and Forms

Document Name Document Type
EDCompanionGuide_837I_120911.pdf Instruction
EDCompanionGuide_837P_120911.pdf Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Collection of Encounter Data from Medicare Advantage Organizations	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 422.310

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			EDCompanionGuide_837I_120911.pdf		Yes	No	Printable Only
Instruction			EDCompanionGuide_837P_120911.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 827	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	517,793,438	517,793,438
Annual IC Time Burden (Hours)	34,520	34,520
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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