Information Collection

Collection of Diagnostic Data from Medicare Advantage Organizations for Risk Adjusted Payments

IC 8640 under ICR 201307-0938-026 · OMB 0938-0838.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

Collection of Diagnostic Data from Medicare Advantage Organizations for Risk Adjusted Payments

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 422.250-422.234 42 CFR 42CFR423.251-423.350 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of 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: 766

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: 99 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	82,830,000	82,829,800	200
Annual IC Time Burden (Hours)	40,650	39,050	1,600
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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