Medicare Parts C and D Universal Audit Guide

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1000 can be found here:

Documents and Forms

Document Name Document Type
Audit Confirmation Letter.pdf Instruction
Sample Request Letter.pdf Instruction
Sample Request Letter_Enclosure IV.pdf Instruction
Sample Request Letter_Enclosure I page 1.pdf Instruction
Medicare Part C & Part D Universal Audit Guide.pdf Medicare Part C & Part D Universal Audit Guide IC Document
Sample Request Letter_Enclosure I continued.pdf Sample Request Letter_Enclosure I continued IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medicare Parts C and D Universal Audit Guide	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 423.505 42 CFR 422.504 42 CFR 423.514

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	Audit Confirmation Letter.pdf	Yes	Yes	Printable Only
Instruction	Sample Request Letter.pdf	Yes	Yes	Printable Only
Instruction	Sample Request Letter_Enclosure IV.pdf	Yes	Yes	Paper Only
Instruction	Sample Request Letter_Enclosure I page 1.pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 195	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: 90 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	195	-235	430
Annual IC Time Burden (Hours)	24,180	-17,100	41,280
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Medicare Part C & Part D Universal Audit Guide	Medicare Part C & Part D Universal Audit Guide.pdf	10/21/2009
Sample Request Letter_Enclosure I continued	Sample Request Letter_Enclosure I continued.pdf	10/21/2009

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