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Requests for Mailed Disclosures
Transparency in Pricing Information (CMS-10715)
OMB: 0938-1429
IC ID: 249943
OMB.report
HHS/CMS
OMB 0938-1429
ICR 202110-0938-016
IC 249943
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1429 can be found here:
2024-10-30 - Revision of a currently approved collection
2024-10-09 - RCF New
Documents and Forms
Document Name
Document Type
CMS-10715-Transparency in Coverage_Appendix 1_Final.pdf
Other-Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Requests for Mailed Disclosures
Agency IC Tracking Number:
CCIIO - 10715
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Mandatory
CFR Citation:
45 CFR 147.210(b)(2)(ii)
Information Collection Instruments:
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
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
653
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
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
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.