GPO Dispute and Resolution Correction

Registration, Attestation, Dispute Resolution and Correction, Assumptions Document and Data Retention Requirements for Open Payments (CMS-10495)

OMB: 0938-1237

IC ID: 238591

Information Collection (IC) Details

View Information Collection (IC)

GPO Dispute and Resolution Correction
 
No Unchanged
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10495 Review and Dispute Screen Shots CMS-10495 - Review And Dispute Screen Shots 9.23.2020 - 508 cf.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10495 Review and Dispute Email Notifications CMS-10495 - Review_and_Dispute_Email_Notifications 9.23.2020 - 508 cf.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

23 0
   
Private Sector Businesses or other for-profits
 
   100 %

  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 23 0 0 0 0 23
Annual IC Time Burden (Hours) 285 0 0 0 0 285
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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