Information Collection

Collection of Diagnostic Data from Medicare Advantage Organizations for Risk Adjusted Payments Supporting Reg 42 CFR Part 422 & 423 Subparts F and G

IC 8704 under ICR 202002-0938-018 · OMB 0938-0878.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0878 can be found here:

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Information Collection (IC) Details

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IC Title:	Collection of Diagnostic Data from Medicare Advantage Organizations for Risk Adjusted Payments Supporting Reg 42 CFR Part 422 & 423 Subparts F and G	Agency IC Tracking Number:	CM-CPC

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 422.250-422.324 42 CFR 423.251-423.350

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: CMS Risk Adjustment Suite of Systems (RASS), HHS/CMS/CM	FR Citation: 80 FR 49237

Number of Respondents: 761	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	111,738,834	28,908,834	82,830,000
Annual IC Time Burden (Hours)	5,586,942	5,546,292	40,650
Annual IC Cost Burden (Dollars)	0	0	0

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