Information Collection

Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516(a)

IC 186859 under ICR 201509-0938-001 · OMB 0938-1054.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1054 can be found here:

Documents and Forms

Document Name Document Type
PartC_Techspecs_2016ReportingYear_Draft__v4 081015 [rev 09-03-2015 by OSORA PRA].pdf Instruction
Crosswalk 080715.pdf Other-Crosswalk

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516(a)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.516(a)(2) 42 CFR 422.516(a)(3) 42 CFR 422.516(a)(4) 42 CFR 422.516(a)(6) 42 CFR 422.516(a)(1)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			PartC_Techspecs_2016ReportingYear_Draft__v4 081015 [rev 09-03-2015 by OSORA PRA].pdf		Yes	Yes	Printable Only
Other-Crosswalk			Crosswalk 080715.pdf		No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 562	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,072	0	-3,643	6,715
Annual IC Time Burden (Hours)	173,943	4,340	45	169,558
Annual IC Cost Burden (Dollars)	0	0	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.