Collecting 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: 8532

Documents and Forms
Document Name
Document Type
Instruction
Other-Sample Report
Information Collection (IC) Details

View Information Collection (IC)

Collecting 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
Instruction CMS-R-0282_Data Form Instructions_2020_v508.pdf Yes No Printable Only
Other-Sample Report CMS-R-0282 Data Form_2020_v508.pdf Yes No Printable Only

Health Health Care Services

 

733 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 733 0 -749 0 0 1,482
Annual IC Time Burden (Hours) 733 0 -749 0 0 1,482
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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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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