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(Self-Funded - Non-Government) Documentation and Data Requirements for NQTL Comparative Analyses
Non-Quantitative Treatment Limitation Analyses and Compliance Under MHPAEA (CMS-10773)
OMB: 0938-1393
IC ID: 270779
OMB.report
HHS/CMS
OMB 0938-1393
ICR 202409-0938-011
IC 270779
( )
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IC Title:
(Self-Funded - Non-Government) Documentation and Data Requirements for NQTL Comparative Analyses
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
45 CFR 146.137
45 CFR 146.136
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
33,076
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
0 %
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
33,076
0
33,076
0
0
0
Annual IC Time Burden (Hours)
1,764,053
0
1,764,053
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
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