Requests for Mailed Disclosures

Transparency in Pricing Information (CMS-10715)

OMB: 0938-1429

IC ID: 249943

Documents and Forms
Document Name
Document Type
Other-Instruction
Information Collection (IC) Details

View Information Collection (IC)

Requests for Mailed Disclosures CCIIO - 10715
 
No New
 
Mandatory
 
45 CFR 147.210(b)(2)(ii)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Instruction CMS-10715-Transparency in Coverage_Appendix 1_Final.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

653 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   54 %

  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 42,463 42,463 0 0 0 0
Annual IC Time Burden (Hours) 10,616 10,616 0 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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