OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Requirements for Provisions of Good Faith Estimates of Expected Charges Upon Request of Uninsured Individuals for Scheduled Items and Services

IC 249567 under ICR 202109-0938-015 · OMB unassigned.

Documents and Forms
Document Name
Document Type
Other-Notice
Information Collection (IC) Details

View Information Collection (IC)

Requirements for Provisions of Good Faith Estimates of Expected Charges Upon Request of Uninsured Individuals for Scheduled Items and Services
 
No New
 
Mandatory
 
45 CFR 149.610

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Notice 1. Right to Receive a Good Faith Estimate of Expected Charges Notice.pdf Yes No Paper Only

Health Health Care Services

 

3,498,942 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   10 %

  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 3,498,942 3,498,942 0 0 0 0
Annual IC Time Burden (Hours) 3,538,305 3,538,305 0 0 0 0
Annual IC Cost Burden (Dollars) 356,717,137 356,717,137 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.