Information Collection

#8: (PIE) Payer Initiated Eligibility/Benefit Transaction

IC 214287 under ICR 201410-0938-016 · OMB 0938-1148.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1148 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PIE - Attachment A PIE Transaction Companion Guide- June 2010 (2).pdf	Instruction
PIE - Attachment B Companion Guide - Business Scenarios (2).pdf	Instruction
PIE - Attachment C SMD10011 (2).pdf	Instruction
#8 PIE Supporting Statement [Dec 2014].docx #8 Supporting Statement: (PIE) Payer Initiated Eligibility/Benefit Transaction	IC Document

IC Title:

#8: (PIE) Payer Initiated Eligibility/Benefit Transaction

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Electronic Capability
Instruction	PIE - Attachment A PIE Transaction Companion Guide- June 2010 (2).pdf	No	Paper Only
Instruction	PIE - Attachment B Companion Guide - Business Scenarios (2).pdf	No	Paper Only
Instruction	PIE - Attachment C SMD10011 (2).pdf	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 56

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	1,120	1,120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
#8 Supporting Statement: (PIE) Payer Initiated Eligibility/Benefit Transaction	#8 PIE Supporting Statement [Dec 2014].docx	12/22/2014

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