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Federal forms, ICRs, and supporting documents

OMB control number

Medicare Health Plan Appeals and Grievance Data Collection and Reporting Requirements, Data Disclosure Requirements under section 422.111 (CMS-R-282)

OMB 0938-0778 ยท 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 Health Plan Appeals and Grievance Data Collection and Reporting Requirements, Data Disclosure Requirements under section 422.111 (CMS-R-282) expires 2026-07-31 and can be found here.

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 Revision of a currently approved collection 2023-02-22
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 Revision of a currently approved collection 2019-11-25
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 Revision of a currently approved collection 2016-07-25
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 Extension without change of a currently approved collection 2013-05-22
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 Extension without change of a currently approved collection 2007-01-12
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 Extension without change of a currently approved collection 2003-11-12
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 Reinstatement without change of a previously approved collection 2000-10-20
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 New collection (Request for a new OMB Control Number) 1999-07-29
OMB Details

Collecting Appeals and Grievance Data

Federal Enterprise Architecture: Health - Health Care Services