Burden Estimates - Appeals

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)

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	Burden Estimates - Appeals	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 147.136

Information Collection Instruments:

Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Model - Notice of Internal Adverse Benefit Determination	Yes	Yes	Fillable Fileable
Other-Model Notice of Adverse Benefit Determination	Yes	Yes	Fillable Fileable
Other-Model Notice of Final External Review Decision	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 91,530	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 58 %

	Requested	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	489,975,255	-26,600,028	516,575,283
Annual IC Time Burden (Hours)	861,470	-334,156	1,195,626
Annual IC Cost Burden (Dollars)	142,092,824	-7,714,008	149,806,832

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.

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