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Federal forms, ICRs, and supporting documents

Information Collection

Provider Network Coverage - Notice to Enrollees

IC 219312 under ICR 202602-0938-009 · OMB 0938-1302.

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Information Collection (IC) Details

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Provider Network Coverage - Notice to Enrollees
 
No Modified
 
Required to Obtain or Retain Benefits
 
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

 

374 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 205,001 0 0 0 0 205,001
Annual IC Time Burden (Hours) 20,500 0 0 0 0 20,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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