Notice of Right to Good Faith Estimate – Individual Physician Practitioners

Requirements Related to Surprise Billing; Part II (CMS-10791)

OMB: 0938-1433

IC ID: 253130

Information Collection (IC) Details

View Information Collection (IC)

Notice of Right to Good Faith Estimate – Individual Physician Practitioners CCIIO - 10791
 
No Unchanged
 
Mandatory
 
45 CFR 149.610

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10791 Right to Receive a Good Faith Estimate of Expected Charges Notice Right to Receive a Good Faith Estimate of Expected Charges Notice.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

145,887 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 145,887 0 0 0 0 145,887
Annual IC Time Burden (Hours) 481,426 0 0 0 0 481,426
Annual IC Cost Burden (Dollars) 75,076,368 0 0 0 0 75,076,368

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.

© 2024 OMB.report | Privacy Policy