Information Collection

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

IC 186859 under ICR 201609-0938-009 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.