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Federal forms, ICRs, and supporting documents

OMB control number

Medicare Advantage Appeals and Grievance Data Form (CMS-R-282)

OMB 0938-0778 · HHS/CMS.

OMB 0938-0778

Medicare Advantage organizations (including MA plans and demonstrations) will collect information on appeals and grievance timeliness measures as well as dispositions. MA organizations will provide appeals and grievance information to individuals eligible to elect an MA organization, when requested, to help them make informed decisions about health plan performance.

The latest form for Medicare Advantage Appeals and Grievance Data Form (CMS-R-282) expires 2029-07-31 and is listed under ICR 202605-0938-006.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
CMS-R-282 - Supporting Statement_ clean.docxSupporting Statement A
Collecting Appeals and Grievance Data Instruction
Reporting Appeals and Grievance Data Other-Sample Report

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202605-0938-006 Extension without change of a currently approved collection 2026-05-13
202302-0938-004 Revision of a currently approved collection 2023-02-22 Approved without change
201910-0938-007 Revision of a currently approved collection 2019-11-25 Approved without change
201607-0938-014 Revision of a currently approved collection 2016-07-25 Approved with change
201305-0938-014 Extension without change of a currently approved collection 2013-05-22 Approved without change
201002-0938-005 Extension without change of a currently approved collection 2010-02-05 Approved without change
200701-0938-013 Extension without change of a currently approved collection 2007-01-12 Approved without change
200311-0938-004 Extension without change of a currently approved collection 2003-11-12 Approved with change
200010-0938-006 Reinstatement without change of a previously approved collection 2000-10-20 Approved without change
199907-0938-012 New collection (Request for a new OMB Control Number) 1999-07-29 Approved without change

OMB Details

Collecting Appeals and Grievance Data

Federal Enterprise Architecture: Health - Health Care Services