OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Reviewing Encounter Data Submission Guidance

IC 246826 under ICR 202403-0938-009 · OMB 0938-1152.

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Reviewing Encounter Data Submission Guidance
 
No Modified
 
Voluntary
 
42 CFR 422.310

Document Type Form No. Form Name Instrument File URL 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 No Printable Only
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 Fileable

Health Health Care Services

 

900 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 900 0 167 0 0 733
Annual IC Time Burden (Hours) 14,400 0 2,672 0 0 11,728
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.