Electronic Data Interchange (EDI) Agreement

Collection of Encounter Data from MA Organizations, Section 1876 Cost HMOs/CMPs, MMPs, and PACE Organizations (CMS-10340)

OMB: 0938-1152

IC ID: 225025

Information Collection (IC) Details

View Information Collection (IC)

Electronic Data Interchange (EDI) Agreement
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10340 MAO Electronic Data Interchange (EDI) Agreement EDI Agreement with OMB a08112020.pdf Yes Yes Fillable Fileable

Health Health Care Services

CMS Encounter Data System (EDS)  83 FR 6591

201 0
   
Private Sector Businesses or other for-profits
 
   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 201 0 0 -490 0 691
Annual IC Time Burden (Hours) 17 0 0 -40 0 57
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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