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Information Collection

Provider Network Coverage - Written Notice of Provider Discontinuation

IC 219311 under ICR 202602-0938-009 · OMB 0938-1302.

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Provider Network Coverage - Written Notice of Provider Discontinuation
 
No Modified
 
Required to Obtain or Retain Benefits
 
45 CFR 156.230(e) 45 CFR 156.156(f)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability

Health Health Care Services

 

747 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 747 0 0 0 0 747
Annual IC Time Burden (Hours) 551,276 0 0 0 0 551,276
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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