Information Collection

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

IC 194762 under ICR 202109-0938-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form CMS-10305 Appendix J_FDCF Medicare Part C and Part D Data Validation (42 CFR 422.516(g) and 423.514(g))	Form and Instruction
Form CMS-10305 Organizational Assessment Instrument Medicare Part C and Part D Data Validation (42 CFR 422.516(g) and 423.514(g))	Form and Instruction
Appendix B DataValidationStandards_508.pdf	Instruction
2022 DV_Appendix B DataValidationStandards_508_20211215.pdf	Instruction
DV Procedure Manual_508.pdf	Instruction
2022 DV_DV Procedure Manual_508_20211215.pdf	Instruction
CMS-10305 Appendix J_FDCF Appendix J_FDCF_Final_06022021_508.xlsx	Form and Instruction
CMS-10305 Appendix J_FDCF Appendix J_FDCF_Final_06022021_508.xlsx	Form and Instruction
CMS-10305 Organizational Assessment Instrument Appendix E Organizational Assessment Instrument_06042021_508.pdf	Form and Instruction
CMS-10305 Organizational Assessment Instrument Appendix E Organizational Assessment Instrument_06042021_508.pdf	Form and Instruction
Appendix B Crosswalk of Changes from CY2020 to CY2022 from 60-Day Comment Period_508.pdf Appendix B Crosswalk	IC Document
Appendix B Crosswalk of Changes from CY2020 to CY2022 from 60-Day Comment Period_508.pdf Appendix B Crosswalk	IC Document
Appendix J Crosswalk of Changes from CY2020 to CY2022 from 60-Day Comment Period_508.pdf Appendix J Crosswalk	IC Document
Appendix J Crosswalk of Changes from CY2020 to CY2022 from 60-Day Comment Period_508.pdf Appendix J Crosswalk	IC Document
Crosswalk of Changes from CY 2020 to CY 2022 - Appendix E_060721.pdf Appendix E: Crosswalk	IC Document
Crosswalk of Changes from CY 2020 to CY 2022 - Appendix E_060721.pdf Appendix E: Crosswalk	IC Document
Crosswalk of Changes from CY 2020 to CY 2022 - DV Manual_060721.pdf DV Manual: Crosswalk	IC Document
Crosswalk of Changes from CY 2020 to CY 2022 - DV Manual_060721.pdf DV Manual: Crosswalk	IC Document

Information Collection (IC) Details

View Information Collection (IC)

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

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction		Yes	No	Printable Only
Instruction		Yes	No	Fillable Printable
Form and Instruction	CMS-10305	Yes	No	Fillable Printable
Form and Instruction	CMS-10305	Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 761

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	761	208	553
Annual IC Time Burden (Hours)	20,946	5,614	15,332
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix B Crosswalk		10/13/2021
Appendix J Crosswalk		10/13/2021
Appendix E: Crosswalk		10/13/2021
DV Manual: Crosswalk		10/13/2021

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

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