OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non-grandfathered Group Health Plans and Issuers and Individual Market Issuers (CMS-10338)

OMB 0938-1099 · HHS/CMS.

OMB 0938-1099

The information collection requirements included in the claims procedure regulation ensure that participants and beneficiaries (claimants) receive adequate information regarding the plan's claims procedures and the plan's handling of specific benefit claims. Participants and beneficiaries need to understand plan procedures and plan decisions in order to appropriately request benefits and/or appeal benefit denials. The information collection requirements are necessary for the Federal external review process to provide an independent external review as requested by claimants.

The latest form for Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non-grandfathered Group Health Plans and Issuers and Individual Market Issuers (CMS-10338) expires 2023-05-31 and is listed under ICR 201911-0938-014.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
CMS-10338 - Supporting Statementf.docxSupporting Statement A
CMS-10338 - 60 day comment.docxPublic Comments
CMS-10338 - 60-day comment response_Sep 2025.pdfSupplementary Document
Internal Claims and Appeals and External Review Procedures Information collection
Burden Estimates - Appeals Other-Model - Notice of Internal Adverse Benefit Determination

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202512-0938-019 Reinstatement without change of a previously approved collection 2026-02-12
202504-0938-011 No material or nonsubstantive change to a currently approved collection 2025-04-11
202412-0938-009 No material or nonsubstantive change to a currently approved collection 2024-12-12 Approved without change
202205-0938-010 Reinstatement without change of a previously approved collection 2022-05-09 Approved without change
202110-0938-001 Revision of a currently approved collection 2021-10-07 Approved with change
201911-0938-014 Extension without change of a currently approved collection 2019-11-30 Approved without change
201606-0938-004 Revision of a currently approved collection 2016-07-01 Approved without change
201503-0938-010 No material or nonsubstantive change to a currently approved collection 2015-03-26 Approved without change
201303-0938-001 Reinstatement without change of a previously approved collection 2013-03-04 Approved with change
201106-0938-021 Revision of a currently approved collection 2011-06-22 Approved with change
201009-0938-010 Revision of a currently approved collection 2010-09-23 Approved without change
201009-0938-006 No material or nonsubstantive change to a currently approved collection 2010-09-21 Approved without change
201008-0938-015 Revision of a currently approved collection 2010-08-20 Approved with change
201008-0938-014 Revision of a currently approved collection 2010-08-20 Approved without change
201007-0938-005 New collection (Request for a new OMB Control Number) 2010-07-20 Preapproved