Information Collection

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

IC 194762 under ICR 201908-0938-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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
CMS_Appendix B DataValidationStandards_FINAL_01212020.pdf	Instruction
DV Procedure Manual_FINAL_03015019.pdf	Instruction
Appendix J_FDCF_Updated_Final_01142020.xlsx	Instruction
CMS-10305 Organizational Assessment Instrument Appendix E Organizational Assessment Instruction_FINAL_03142019.pdf	Form and Instruction
Crosswalk_Appendix B.csv Appendix B Crosswalk	IC Document
Crosswalk_Appendix J.csv Appendix J Crosswalk	IC Document

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 422.516(a)(3),(a)(4),(a)(6) 42 CFR 423.514 (a)(1) (a) (2) 42 CFR 423.514 (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			DV Procedure Manual_FINAL_03015019.pdf	Yes	No	Fillable Printable
Form and Instruction	CMS-10305	Organizational Assessment Instrument	Appendix E Organizational Assessment Instruction_FINAL_03142019.pdf	Yes	Yes	Fillable Printable
Instruction			CMS_Appendix B DataValidationStandards_FINAL_01212020.pdf	Yes	No	Printable Only
Instruction			Appendix J_FDCF_Updated_Final_01142020.xlsx	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 553

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	553	-21	574
Annual IC Time Burden (Hours)	15,332	-8,718	24,050
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix B Crosswalk	Crosswalk_Appendix B.csv	01/22/2020
Appendix J Crosswalk	Crosswalk_Appendix J.csv	01/22/2020

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