Information Collection

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

IC 194762 under ICR 201801-0938-010 · 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⚠️ Notice: This information collection may be referencing outdated material.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 B DataValidationStandards_FINAL_03022018.pdf	Instruction
DV Procedure Manual_01.16.18.pdf	Instruction
Appendix J FDCF FINAL_03022018.pdf	Instruction
CMS-10305 Organizational Assessment Instrument Appendix E Organizational Assessment Instruction_01.16.2018.pdf	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 423.514 (a)(3) (a) (4) (a) (6) 42 CFR 422.516(a)(3),(a)(4),(a)(6) 42 CFR 423.514 (a)(1) (a) (2) 42 CFR 422.516_(a)(1),(a)(2)

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 J FDCF FINAL_03022018.pdf	Yes	No	Printable Only
Instruction			Appendix B DataValidationStandards_FINAL_03022018.pdf	Yes	No	Printable Only
Instruction			DV Procedure Manual_01.16.18.pdf	Yes	Yes	Fillable Printable
Form and Instruction	CMS-10305	Organizational Assessment Instrument	Appendix E Organizational Assessment Instruction_01.16.2018.pdf	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 574

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	574	0	-65	639
Annual IC Time Burden (Hours)	24,050	-23,825	-161,398	209,273
Annual IC Cost Burden (Dollars)	0	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.