Information Collection

Allowed Amount File

IC 249967 under ICR 202110-0938-016 · OMB 0938-1429.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1429 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10715 Allowed Amount File Form and Instruction
CMS-10715 APPENDIX 2: In-network Rate Machine-Readable File Data E CMS-10715-Transparency in Coverage_Appendix 2_Final .pdf Form and Instruction
CMS-10715 APPENDIX 3: The Allowed Amount Machine-Readable File Dat CMS-10715-Transparency in Coverage_Appendix 3_.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Allowed Amount File	Agency IC Tracking Number:	CCIIO - 10715

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 147.210(c)(1)(ii)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10715	APPENDIX 2: In-network Rate Machine-Readable File Data Elements	CMS-10715-Transparency in Coverage_Appendix 2_Final .pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10715	APPENDIX 3: The Allowed Amount Machine-Readable File Data Elements	CMS-10715-Transparency in Coverage_Appendix 3_.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,163	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	8,163	8,163
Annual IC Time Burden (Hours)	1,616,828	1,616,828
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.