Reporting Appeals and Grievance Data

Medicare Health Plan Appeals and Grievance Data Collection and Reporting Requirements, Data Disclosure Requirements under section 422.111 (CMS-R-282)

OMB: 0938-0778

IC ID: 46763

Documents and Forms
Information Collection (IC) Details

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Reporting Appeals and Grievance Data
 
No Modified
 
Mandatory
 
42 CFR 422.111(c)(3)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Sample Report CMS-R-0282 Sample Form-2015-v508-FINAL (rev Jan 2017).docx Yes No Printable Only
Instruction FORM INSTRUCTIONS CMS-R-0282-2015-v508-FINAL [rev Jan 2017].docx Yes No Printable Only

Health Health Care Services

 

741 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved 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 55,300 0 0 4,380 0 50,920
Annual IC Time Burden (Hours) 4,424 0 0 350 0 4,074
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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