OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Monitoring and appeals process for survey vendors

IC 212011 under ICR 202508-0938-006 · OMB 0938-1249.

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

View Information Collection (IC)

Monitoring and appeals process for survey vendors
 
No Modified
 
Voluntary
 
45 CFR 156.200(b)(5) 45 CFR 156.1105 45 CFR 155.200(d) 45 CFR 156.1120-1125

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10520 Vendor Appeal Form CMS-10520 - QHP Survey - Request for Appeal Form.docx Yes Yes Fillable Fileable

Health Health Care Services

 

6 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 6 0 0 -8 0 14
Annual IC Time Burden (Hours) 6 0 0 -8 0 14
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].