OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

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

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

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

#8: (PIE) Payer Initiated Eligibility/Benefit Transaction
 
New
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted 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

Health Health Care Services

 

56 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 56 0 56 0 0 0
Annual IC Time Burden (Hours) 1,120 0 1,120 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.