Information Collection

Group Health Plans Internal Claims and Appeals and External Review Processes

IC 193852 under ICR 202301-1545-016 · OMB 1545-2182.

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Information Collection (IC) Details

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IC Title:	Group Health Plans Internal Claims and Appeals and External Review Processes	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 2560.503-1 29 CFR 2590.715-2719

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,007,298	Number of Respondents for Small Entity: 1,746,349

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

Percentage of Respondents Reporting Electronically: 58 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	314,560	159,395	155,165
Annual IC Time Burden (Hours)	14,432	14,083	349
Annual IC Cost Burden (Dollars)	571,599	-178,938	750,537

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.