Information Collection

Medicare Advantage Program Requirements Referenced in 42 CFR Part 422 (CMS-R-267 for MAOs)

IC 8462 under ICR 200806-0938-001 · OMB 0938-0753.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0753 can be found here:

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Information Collection (IC) Details

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IC Title:	Medicare Advantage Program Requirements Referenced in 42 CFR Part 422 (CMS-R-267 for MAOs)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.620 42 CFR 422.152 42 CFR 422.458 42 CFR 422.254 42 CFR 422.270 42 CFR 422.304 42 CFR 422.310 42 CFR 422.314 42 CFR 422.320 42 CFR 422.4 42 CFR 422.52 42 CFR 422.54 42 CFR 422.60 42 CFR 422.62 42 CFR 422.64 42 CFR 422.66 42 CFR 422.74 42 CFR 422.80 42 CFR 422.101 42 CFR 422.103 42 CFR 422.105 42 CFR 422.106 42 CFR 422.107 42 CFR 422.111 42 CFR 422.112 42 CFR 422.113 42 CFR 422.118 42 CFR 422.128 42 CFR 422.132 42 CFR 422.118 42 CFR 422.156 42 CFR 422.157 42 CFR 422.158 42 CFR 422.202 42 CFR 422.204 42 CFR 422.205 42 CFR 422.206 42 CFR 422.216 42 CFR 422.400 42 CFR 422.503 42 CFR 422.504 42 CFR 422.506 42 CFR 422.508 42 CFR 422.510 42 CFR 422.512 42 CFR 422.516 42 CFR 422.550 42 CFR 422.562 42 CFR 422.564 42 CFR 422.568 42 CFR 422.570 42 CFR 422.572 42 CFR 422.582 42 CFR 422.584 42 CFR 422.590 42 CFR 422.594 42 CFR 422.600 42 CFR 422.602 42 CFR 422.608 42 CFR 422.612 42 CFR 422.624 42 CFR 422.626 42 CFR 422.650 42 CFR 422.662 42 CFR 422.668 42 CFR 422.670 42 CFR 422.686 42 CFR 422.690 42 CFR 422.698 42 CFR 422.2260 42 CFR 422.2262 42 CFR 422.2264 42 CFR 422.2268 42 CFR 422.2272 42 CFR 422.2274 42 CFR 422.501

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 670	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	670	-670	-13,120,067	13,121,407
Annual IC Time Burden (Hours)	7,061,701	850,616	4,146,646	2,064,439
Annual IC Cost Burden (Dollars)	0	0	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.