Medicare Advantage Program Requirements Referenced in 42 CFR Part 422 (CMS-R-267 for Beneficiaries)

Medicare Advantage Program Requirements Referenced in 42 CFR Part 422

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Documents and Forms

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Information Collection (IC) Details

IC Title:	Medicare Advantage Program Requirements Referenced in 42 CFR Part 422 (CMS-R-267 for Beneficiaries)	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 422.50

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: 9,000,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	9,000,000	9,000,000
Annual IC Time Burden (Hours)	1,500,000	1,500,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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