Information Collection

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IC 249983 under ICR 202601-0938-002 · OMB 0938-1429.

Documents and Forms

Document Name Document Type
CMS-10715-Transparency in Coverage_Appendix 4_.pdf Other-Data Elements

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	-	Agency IC Tracking Number:	CCIIO - 10715

Is this a Common Form? Yes		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 45 CFR 147.210(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Data Elements			CMS-10715-Transparency in Coverage_Appendix 4_.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1	-8,162	8,163
Annual IC Time Burden (Hours)	1	-1,009,537	1,009,538
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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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