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

Documents and forms in this information collection
Document Name	Document Type
CMS-10715 (Appendix 2) In-network Rate File 508.pdf	Other-In-network Rate Machine-Readab
CMS-10715 (Appendix 3) Allowed Amount File 508.pdf	Other-The Allowed Amount Machine-Rea
CMS-10715 (Appendix 4) Prescription Drug File 508.pdf	Other-Prescription Drug Machine-Read
CMS-10715 (Appendix 5) Change Log File 508.pdf	Other-The Change-Log Machine-Readabl
CMS-10715 (Appendix 6) Utilization File 508.pdf	Other-The Utilization Machine-Readab
CMS-10715 (Appendix 7) Taxonomy File 508.pdf	Other-The Taxonomy Machine-Readable
CMS-10715 (Appendix 8) Text File 508.pdf	Other-The Text Machine-Readable File

IC Title:

Agency IC Tracking Number:

CCIIO - 10715

Is this a Common Form? Yes

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 147.210(c)(1)(i)

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-In-network Rate Machine-Readable File Data Elements	Yes	Yes	Paper Only
Other-The Allowed Amount Machine-Readable File Data Elements	Yes	Yes	Paper Only
Other-Prescription Drug Machine-Readable File Data Elements	Yes	Yes	Paper Only
Other-The Change-Log Machine-Readable File Data Elements	Yes	Yes	Paper Only
Other-The Utilization Machine-Readable File Data Elements	Yes	Yes	Paper Only
Other-The Taxonomy Machine-Readable File Data Elements	Yes	Yes	Paper Only
Other-The Text Machine-Readable File Data Elements	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 790

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: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	790	-7,373	8,163
Annual IC Time Burden (Hours)	3,204,240	71,146	3,133,094
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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