Information Collection

Reviewing Encounter Data Submission Guidance

IC 246826 under ICR 202502-0938-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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:

Reviewing Encounter Data Submission Guidance

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 422.310

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	Yes	No	Printable Only
Instruction	Yes	No	Printable Only
Instruction	Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

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	Previously Approved
Annual Number of Responses for this IC	900	900
Annual IC Time Burden (Hours)	14,400	14,400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk		03/14/2024

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

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