Information Collection

Encounter Data Submission

IC 199936 under ICR 202606-0938-007 · OMB 0938-1152.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Medicare Advantage Supplemental Dental Services Submission Guide 2-28-2024 Clean 1.1 (1).docx	Instruction
Medicare Advantage Supplemental Dental Services Submission Guide 2-28-2024 Clean 1.1 (1).docx	Instruction
Medicare Advantage Dental Validation Report Layout Clean 2-28-2024.docx	Instruction
Medicare Advantage Dental Validation Report Layout Clean 2-28-2024.docx	Instruction
ED_Submission_Processing_Guide_20201009.pdf	Instruction
ED_Submission_Processing_Guide_20201009.pdf	Instruction
Medicare Advantage Supplemental Dental Services Submission Guide Crosswalk 2-28-2024.xlsx Crosswalk	IC Document
Medicare Advantage Supplemental Dental Services Submission Guide Crosswalk 2-28-2024.xlsx Crosswalk	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 422.310

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	Yes	Yes	Fillable Printable
Instruction	Yes	No	Printable Only
Instruction	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: CMS Encounter Data System (EDS)

FR Citation: 83 FR 6591

Number of Respondents: 900

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,467,645,179	1,467,645,179
Annual IC Time Burden (Hours)	48,921,506	48,921,506
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk		03/14/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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