Dispute Resolution and Correction (Physicians)

Registration, Attestation, Dispute Resolution and Correction, Assumptions Document and Data Retention Requirements for Open Payments (CMS-10495)

OMB: 0938-1237

IC ID: 212216

Information Collection (IC) Details

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Dispute Resolution and Correction (Physicians)
 
No Modified
 
Mandatory
 
42 CFR 403.908

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10495 Dispute Resolution and Correction CMS-10495 - Review And Dispute Screen Shots.pdf Yes Yes Fillable Fileable Signable

Health Health Care Services

 

31,897 0
   
Individuals or Households
 
   100 %

  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 31,897 0 0 -192,528 0 224,425
Annual IC Time Burden (Hours) 146,088 0 0 -1,200,462 0 1,346,550
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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