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Federal forms, ICRs, and supporting documents

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Medicare Parts C and D Universal Audit Guide

IC 43683 under ICR 201307-0938-024 · OMB 0938-1000.

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Other-Template - OEV Universe
Instruction
Other-Template - ODAG Universe
Instruction
Instruction
Instruction
Other-Template - CDAG Universe
Instruction
Other-Template - FA Universe
Instruction
Other-Template - SNP MOC Universe
Other-template - Organizational Stru
Instruction
Instruction
Form
Form
Form
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

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Medicare Parts C and D Universal Audit Guide
 
No Modified
 
Mandatory
 
42 CFR 422.504 42 CFR 423.505 42 CFR 423.514

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Medicare_Part_C__Part_D_Universal_Audit_Guide_07_10_13 CLEAN--REDUCED [rev 11-13-2013 by OSORA PRA].pdf Yes No Printable Only
Instruction Attachment X - OEV Protocol Audit Process and Universe Request--REDUCED.pdf Yes No Printable Only
Other-Template - OEV Universe Attachment X - A - OEV Universe Template--REDUCED.pdf Yes Yes Printable Only
Instruction Attachment VIII - 2013 Audit Process Document--REDUCED.pdf Yes No Printable Only
Other-Template - ODAG Universe Attachment VII-A - ODAG Universe Template --REDUCED.pdf Yes Yes Fillable Printable
Instruction Attachment VII ODAG Audit Process and Universe Request--REDUCED.pdf Yes No Printable Only
Form CMS-10191 Self Disclosure Report Attachment VI -Self Disclosure Report--REDUCED.pdf Yes Yes Fillable Printable
Instruction Attachment I-B - FA Sample Case Minimum Documentation Required--REDUCED.pdf Yes No Printable Only
Instruction Attachment IX - SNP MOC Audit Process and Universe Request--REDUCED.pdf Yes No Printable Only
Other-Template - CDAG Universe Attachment II-A - CDAG Universe Template--REDUCED.pdf Yes Yes Printable Only
Instruction Attachment II - CDAG Audit Process and Universe Request--REDUCED.pdf Yes No Printable Only
Other-Template - FA Universe Attachment I-A - FA Universe Template--REDUCED.pdf Yes Yes Printable Only
Instruction Attachment I - FA Audit Process and Universe Request--REDUCED.pdf Yes No Printable Only
Other-Template - SNP MOC Universe Att IX-A - SNP MOC Universe Template--REDUCED.pdf Yes Yes Printable Only
Form CMS-10191 CPE SELF-ASSESSMENT QUESTIONNAIRE 5-2013 12-21-12-Attachment V - CPE Self-Assessment Questionnaire--REDUCED.pdf Yes Yes Fillable Printable
Other-template - Organizational Structure and Governance 4-2013 12-21-12-Attachment IV Organization Governance Template--REDUCED.pdf Yes No Printable Only
Form CMS-10191 Key Contacts for Compliance Program Operations 3-2013 12-21-12-Attachment III-B Compliance Program Contacts--REDUCED.pdf Yes Yes Fillable Printable
Instruction 2-2013 12-21-12-Attachment III-A Sample Case File Documentation--REDUCED.pdf Yes No Printable Only
Instruction 2.13.13 - 2013 CPE Attachment III -Data and Document Request [rev 7-21-13 by OSORA PRA]--REDUCED.pdf Yes No Printable Only

Health Health Care Services

 

195 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   90 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 195 0 0 0 195 0
Annual IC Time Burden (Hours) 23,595 0 0 -585 24,180 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
PRA - Crosswalk - Protocol 2012- 2013 changes v2--REDUCED PRA - Crosswalk - Protocol 2012- 2013 changes v2--REDUCED.PDF 07/24/2013
PRA - Crosswalk - Engagement Letter CLEAN 7_9_13--REDUCED PRA - Crosswalk - Engagement Letter CLEAN 7_9_13--REDUCED.pdf 07/24/2013
PRA - Crosswalk - Universal Audit Guide _07_02_13--REDUCED PRA - Crosswalk - Universal Audit Guide _07_02_13--REDUCED.pdf 07/24/2013
PRA - Crosswalk - Auidt Process CLEAN 7_10_13--REDUCED PRA - Crosswalk - Auidt Process CLEAN 7_10_13--REDUCED.pdf 07/24/2013
Engagement Letter/Start Notice Appendix P - Engagement Letter_Start Notice-REDUCED.pdf 07/24/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.