Information Collection

Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516 (a) - (CMS-10261)

IC 186859 under ICR 201105-0938-008 · OMB 0938-1054.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1054 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10261 Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516 (a) - (CMS-10261) Form
CMS-10261 Attachment I - Part C Reporting Overview Attachment I.9.23.08.doc Form
CMS-10261 Attachment III - Medicare Advantage Medical Utilization Attachment III-9-22-08.xls Form
CMS-10261 Medicare Part C Reporting Requirements Attachment II Part C Reporting Overview 9 25 08.doc Form and Instruction
Summary of Revisions-9-25-08.doc Summary of Revisions-9-25-08 IC Document
Attachment IV.Part C _9.22.08.doc Attachment IV IC Document
Attachment V_PartC_09.22.08.doc Attachment V_PartC_09 IC Document
TRK-Attachment I.changes.9.23.08.doc TRK-Attachment I IC Document
TRK-Attachment II changes.09-22-08.doc TRK-Attachment II changes IC Document
TRK-Attachment III-changes.xls TRK-Attachment III-changes IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516 (a) - (CMS-10261)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

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

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10261	Attachment I - Part C Reporting Overview	Attachment I.9.23.08.doc	Yes	Yes	Paper Only
Form	CMS-10261	Attachment III - Medicare Advantage Medical Utilization and Expenditure Experience	Attachment III-9-22-08.xls	No	No	Paper Only
Form and Instruction	CMS-10261	Medicare Part C Reporting Requirements	Attachment II Part C Reporting Overview 9 25 08.doc	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 588	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	8,445	-4,264	12,709
Annual IC Time Burden (Hours)	208,920	-78,024	286,944
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Summary of Revisions-9-25-08	Summary of Revisions-9-25-08.doc	09/26/2008
Attachment IV	Attachment IV.Part C _9.22.08.doc	09/26/2008
Attachment V_PartC_09	Attachment V_PartC_09.22.08.doc	09/26/2008
TRK-Attachment I	TRK-Attachment I.changes.9.23.08.doc	09/26/2008
TRK-Attachment II changes	TRK-Attachment II changes.09-22-08.doc	09/26/2008
TRK-Attachment III-changes	TRK-Attachment III-changes.xls	09/26/2008

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