Burden Estimates

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1099 can be found here:

Documents and Forms

Document Name Document Type
CMS-10338 Letter to Issuers.pdf Instruction
CMS-10338 Letter to Issuers in Territories.pdf Instruction
CMS-10338 CMS-10338 abd_model_notice CMS-10338 abd_model_notice.pdf Form and Instruction
CMS-10338 CMS-10338 final_iabd_model_notice CMS-10338 final_iabd_model_notice.pdf Form and Instruction
CMS-10338 CMS-10338 external_final_decision_model_notice CMS-10338 external_final_decision_model_notice.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Burden Estimates	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 147.136

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CMS-10338 Letter to Issuers.pdf	Yes	No	Fillable Fileable
Instruction			CMS-10338 Letter to Issuers in Territories.pdf	Yes	No	Fillable Fileable
Form and Instruction	CMS-10338	CMS-10338 abd_model_notice	CMS-10338 abd_model_notice.pdf	Yes	No	Fillable Fileable
Form and Instruction	CMS-10338	CMS-10338 final_iabd_model_notice	CMS-10338 final_iabd_model_notice.pdf	Yes	No	Fillable Fileable
Form and Instruction	CMS-10338	CMS-10338 external_final_decision_model_notice	CMS-10338 external_final_decision_model_notice.pdf	Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 46,773	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	218,000,000	147,165,403	70,834,597
Annual IC Time Burden (Hours)	930,000	-267	930,267
Annual IC Cost Burden (Dollars)	52,000,000	15,224,933	36,775,067

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.