Collection of Diagnostic Data from Medicare Advantage Organizations for Risk Adjusted Payments Supporting Reg 42 CFR Part 422 & 423 Subparts F and G

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0878 can be found here:

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Information Collection (IC) Details

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IC Title:	Collection of Diagnostic Data from Medicare Advantage Organizations for Risk Adjusted Payments Supporting Reg 42 CFR Part 422 & 423 Subparts F and G	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 423.251-423.350 42 CFR 422.250-422.324

Information Collection 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: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	82,830,000	60,732,930	22,097,070
Annual IC Time Burden (Hours)	40,650	29,824	10,826
Annual IC Cost Burden (Dollars)	0	0	0

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