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Federal forms, ICRs, and supporting documents

Information Collection

ICRs Regarding Requirements for Public Disclosure of In-network Rates (Annual)

IC 249944 under ICR 202601-0938-002 · OMB 0938-1429.

Documents and Forms
Document Name
Document Type
Other-In-network Rate Machine-Readab
Other-The Allowed Amount Machine-Rea
Other-Prescription Drug Machine-Read
Other-The Change-Log Machine-Readabl
Other-The Utilization Machine-Readab
Other-The Taxonomy Machine-Readable
Other-The Text Machine-Readable File
Information Collection (IC) Details

View Information Collection (IC)

ICRs Regarding Requirements for Public Disclosure of In-network Rates (Annual) CCIIO - 10715
 
Yes Modified
 
Mandatory
 
45 CFR 147.210(c)(1)(i)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-In-network Rate Machine-Readable File Data Elements CMS-10715 (Appendix 2) In-network Rate File 508.pdf Yes Yes Paper Only
Other-The Allowed Amount Machine-Readable File Data Elements CMS-10715 (Appendix 3) Allowed Amount File 508.pdf Yes Yes Paper Only
Other-Prescription Drug Machine-Readable File Data Elements CMS-10715 (Appendix 4) Prescription Drug File 508.pdf Yes Yes Paper Only
Other-The Change-Log Machine-Readable File Data Elements CMS-10715 (Appendix 5) Change Log File 508.pdf Yes Yes Paper Only
Other-The Utilization Machine-Readable File Data Elements CMS-10715 (Appendix 6) Utilization File 508.pdf Yes Yes Paper Only
Other-The Taxonomy Machine-Readable File Data Elements CMS-10715 (Appendix 7) Taxonomy File 508.pdf Yes Yes Paper Only
Other-The Text Machine-Readable File Data Elements CMS-10715 (Appendix 8) Text File 508.pdf Yes Yes Paper Only

Health Health Care Services

 

790 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  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 790 0 0 -7,373 0 8,163
Annual IC Time Burden (Hours) 3,204,240 0 0 71,146 0 3,133,094
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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