Information Collection

Medicare Part C and Part D Data Validation (42 CFR 422.516(g) and 423.514(g))

IC 194762 under ICR 201612-0938-004 · OMB 0938-1115.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1115 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix 1_DataValidationStandards_CMS_10305_Optimal_2016 10 17_clean.docx	Instruction
Appendix 4 DV Procedure Manual_Version 7_10272016.docx	Instruction
Appendix 3 FDCF_Optimal_2016 10 17_final clean.xlsx	Instruction
CMS-10305 Appendix 2: Organizational Assessment Instrument Appendix 2 Organizational Assessment Instruction_Optimal 2016 10 13.docx	Form and Instruction

IC Title:

Medicare Part C and Part D Data Validation (42 CFR 422.516(g) and 423.514(g))

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.516_(a)(1),(a)(2) 42 CFR 423.514 (a)(1) (a) (2) 42 CFR 423.514 (a)(3) (a) (4) (a) (6) 42 CFR 422.516(a)(3),(a)(4),(a)(6)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Appendix 1_DataValidationStandards_CMS_10305_Optimal_2016 10 17_clean.docx	Yes	No	Printable Only
Instruction			Appendix 4 DV Procedure Manual_Version 7_10272016.docx	Yes	Yes	Fillable Printable
Form and Instruction	CMS-10305	Appendix 2: Organizational Assessment Instrument	Appendix 2 Organizational Assessment Instruction_Optimal 2016 10 13.docx	Yes	Yes	Fillable Printable
Instruction			Appendix 3 FDCF_Optimal_2016 10 17_final clean.xlsx	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 269

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	639	-67	706
Annual IC Time Burden (Hours)	209,273	6,695	202,578
Annual IC Cost Burden (Dollars)	0	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.