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

Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516(a) (CMS-10261)

⚠️ Notice: This information collection may be referencing outdated material.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
CY2017 Part C Reporting Requirements 08_12_16.v3.pdf Instruction
Crosswalk_PartC_2017_18_60_day_CMS10261.docx Crosswalk: Technical Specifications Document IC Document

Information Collection (IC) Details

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

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CY2017 Part C Reporting Requirements 08_12_16.v3.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 544	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	Previously Approved
Annual Number of Responses for this IC	3,508	436	3,072
Annual IC Time Burden (Hours)	169,077	-12,946	182,023
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk: Technical Specifications Document	Crosswalk_PartC_2017_18_60_day_CMS10261.docx	09/23/2016

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