Information Collection

Medicare Part C and Part D Data Validation (42 C.F.R. 422.516g and 423.514g) - (CMS-10305)

IC 194762 under ICR 201009-0938-021 · OMB 0938-1115.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1115 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10305 Medicare Part C and Part D Measure Organizational Assessment Instrument Medicare Part C and Part D Data Validation (42 C.F.R. 422.516g and 423.514g) - (CMS-10305)	Form and Instruction
Form CMS-10305 Findings Data Collection Form: Benefit Utilization Medicare Part C and Part D Data Validation (42 C.F.R. 422.516g and 423.514g) - (CMS-10305)	Form
2 DRAFT_Data Extraction and Sampling Instructions_20100826_508.pdf	Instruction
3 DRAFT Data Validation Standards 20100826_508.pdf	Instruction
4 DRAFT Findings Data Collection Form Intro_20100826_508.pdf	Instruction
CMS-10305 Medicare Part C and Part D Measure Organizational Assess 1 DRAFT Organizational Assessment Instrument 20100826_508.pdf	Form and Instruction
CMS-10305 Findings Data Collection Form: Benefit Utilization 5 DRAFT Findings Data Collection Form_20100826_508.pdf	Form

IC Title:

Medicare Part C and Part D Data Validation (42 C.F.R. 422.516g and 423.514g) - (CMS-10305)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.516_(a)(1),(a)(2) 42 CFR 422.516(a)(3),(a)(4),(a)(6) 42 CFR 423.514 (a)(1) (a) (2) 42 CFR 423.514 (a)(3) (a) (4) (a) (6)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10305	Yes	Yes	Paper Only
Instruction		Yes	Yes	Paper Only
Instruction		Yes	Yes	Paper Only
Instruction		Yes	Yes	Paper Only
Form	CMS-10305	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 634

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	634	634
Annual IC Time Burden (Hours)	237,127	237,127
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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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