OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Burden Estimates - Appeals

IC 193861 under ICR 202504-0938-011 · OMB 0938-1099.

Documents and Forms
Document Name
Document Type
Other-Model - Notice of Internal Adv
Other-Model - Notice of Internal Adv
Other-Model Notice of Adverse Benefi
Other-Model Notice of Adverse Benefi
Other-Model Notice of Final External
Other-Model Notice of Final External
Information Collection (IC) Details

View Information Collection (IC)

Burden Estimates - Appeals
 
No Modified
 
Mandatory
 
45 CFR 147.136

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Model - Notice of Internal Adverse Benefit Determination Model Notice of Internal Adverse Benefit Determination_01.29.25.docx Yes Yes Fillable Fileable
Other-Model Notice of Adverse Benefit Determination Model Notice of Adverse Benefit Determination_01.29.25.docx Yes Yes Fillable Fileable
Other-Model Notice of Final External Review Decision Model Notice of Final External Review Decision_01.29.25.docx Yes Yes Fillable Fileable

Health Health Care Services

 

109,653 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 516,575,283 0 0 0 0 516,575,283
Annual IC Time Burden (Hours) 1,195,626 0 0 0 0 1,195,626
Annual IC Cost Burden (Dollars) 149,806,832 0 0 0 0 149,806,832

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.