RADV Training Information Collection

Evaluation of Risk Adjustment Data Validation (RADV) Appeals and Health Insurance Exchange Outreach Training Sessions (CMS-10764)

Documents and Forms

Document Name Document Type
Form CMS-10764 RADV Training Information Collection Form and Instruction
CMS-10764 Appendix A - RADV Instrument CMS_10764_AppendixA_RADV_Instrument_5CR_102120.pdf Form and Instruction
CMS-10764 Appendix A - RADV Instrument CMS_10764_AppendixA_RADV_Instrument_5CR_102120.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	RADV Training Information Collection	Agency IC Tracking Number:	CPI -10764

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 422.310(e)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10764	Appendix A - RADV Instrument	CMS_10764_AppendixA_RADV_Instrument_5CR_102120.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,270	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: 0 %

	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	4,270	4,270
Annual IC Time Burden (Hours)	1,068	1,068
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.