Information Collection

Collecting Appeals and Grievance Data

IC 8532 under ICR 202605-0938-006 · OMB 0938-0778.

Documents and Forms

Document Name Document Type
CMS-R-0282_Data Form Instructions_2026_.docx Instruction
CMS-R-0282 Data Form_2026_clean_.docx Other-Sample Report

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Collecting Appeals and Grievance Data	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.111(c)(3)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CMS-R-0282_Data Form Instructions_2026_.docx		Yes	No	Printable Only
Other-Sample Report			CMS-R-0282 Data Form_2026_clean_.docx		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 932	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: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	932	-8	940
Annual IC Time Burden (Hours)	932	-8	940
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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