Reimbursement Denial Letter and Appeal Notification - Providers

World Trade Center Health Program Enrollment, Appeals & Reimbursement

OMB: 0920-0891

IC ID: 233096

Information Collection (IC) Details

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Reimbursement Denial Letter and Appeal Notification - Providers
 
No New
 
Required to Obtain or Retain Benefits
 
42 CFR 88.23

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Reimbursement Denial Letter and Appeal Notification - Providers App TT Reimbursement Appeal Decision Letter.docx No   Printable Only

Health Health Care Services

09-20-0147 Occupational Health Epidemiologic Studies and EEOICPA Program Records and WTC Health Program Records HHS/CDC/NIOSH  76 FR 34706

600 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 600 0 600 0 0 0
Annual IC Time Burden (Hours) 300 0 300 0 0 0
Annual IC Cost Burden (Dollars) 30,000 0 30,000 0 0 0

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