Information Collection

Encounter Data Submission

IC 199936 under ICR 202403-0938-009 · OMB 0938-1152.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1152 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Medicare Advantage Supplemental Dental Services Submission Guide 2-28-2024 Clean 1.1 (1).docx	Instruction
Medicare Advantage Supplemental Dental Services Submission Guide 2-28-2024 Clean 1.1 (1).docx	Instruction
Medicare Advantage Dental Validation Report Layout Clean 2-28-2024.docx	Instruction
Medicare Advantage Dental Validation Report Layout Clean 2-28-2024.docx	Instruction
ED_Submission_Processing_Guide_20201009.pdf	Instruction
ED_Submission_Processing_Guide_20201009.pdf	Instruction
Medicare Advantage Supplemental Dental Services Submission Guide Crosswalk 2-28-2024.xlsx Crosswalk	IC Document
Medicare Advantage Supplemental Dental Services Submission Guide Crosswalk 2-28-2024.xlsx Crosswalk	IC Document

IC Title:

Encounter Data Submission

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 422.310

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	Medicare Advantage Supplemental Dental Services Submission Guide 2-28-2024 Clean 1.1 (1).docx	Yes	Yes	Fillable Printable
Instruction	Medicare Advantage Dental Validation Report Layout Clean 2-28-2024.docx	Yes	No	Printable Only
Instruction	ED_Submission_Processing_Guide_20201009.pdf	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: CMS Encounter Data System (EDS)

FR Citation: 83 FR 6591

Number of Respondents: 900

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,467,645,179	399,440,750	1,068,204,429
Annual IC Time Burden (Hours)	48,921,506	13,314,692	35,606,814
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk	Medicare Advantage Supplemental Dental Services Submission Guide Crosswalk 2-28-2024.xlsx	03/14/2024

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