Collection of Encounter Data from Medicare Advantage Organizations

Collection of Encounter Data from Medicare Advantage Organizations (CMS-10340)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.