Additional Information to Be Shared with the Initial Payment or Notice of Denial of Payment

No Surprises Act: IDR Process

OMB: 1210-0169

IC ID: 254938

Information Collection (IC) Details

View Information Collection (IC)

Additional Information to Be Shared with the Initial Payment or Notice of Denial of Payment
 
Yes Modified
 
Mandatory
 
29 CFR 2590

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Document Removed Removed - Additional Information to Be Shared with the Initial Payment or Notice of Denial of Payment.docx No   Paper Only

Income Security General Retirement and Disability

 

0 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   95 %

  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 0 0 0 -127,955 0 127,955
Annual IC Time Burden (Hours) 0 0 0 -21,326 0 21,326
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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