Information Collection

Collection of Encounter Data from Medicare Advantage Organizations

IC 199936 under ICR 201508-0938-001 · OMB 0938-1152.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1152 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10340 Collection of Encounter Data from Medicare Advantage Organizations	Form and Instruction
CMS-10340 Electronic Data Interchange (EDI) Agreement ALL INCLUSIVE EDI AGREEMENT v4.pdf	Form and Instruction

IC Title:

Collection of Encounter Data from Medicare Advantage Organizations

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 422.310

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
Form and Instruction	CMS-10340	Electronic Data Interchange (EDI) Agreement	ALL INCLUSIVE EDI AGREEMENT v4.pdf		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 683

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	516,493,635	516,493,635
Annual IC Time Burden (Hours)	34,433	34,433
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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