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

Medicare Part C and Part D Data Validation (42 CFR 422.516(g) and 423.514(g)) (CMS-10305)

OMB: 0938-1115

IC ID: 194762

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1115 can be found here:

Documents and Forms

Document Name Document Type
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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			2022 DV_Appendix B DataValidationStandards_508_20211215.pdf	Yes	No	Printable Only
Instruction			2022 DV_DV Procedure Manual_508_20211215.pdf	Yes	No	Fillable Printable
Form and Instruction	CMS-10305	Appendix J_FDCF	Appendix J_FDCF_Final_06022021_508.xlsx	Yes	No	Fillable Printable
Form and Instruction	CMS-10305	Organizational Assessment Instrument	Appendix E Organizational Assessment Instrument_06042021_508.pdf	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 %

	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

Title	Document	Date Uploaded
Appendix B Crosswalk	Appendix B Crosswalk of Changes from CY2020 to CY2022 from 60-Day Comment Period_508.pdf	10/13/2021
Appendix J Crosswalk	Appendix J Crosswalk of Changes from CY2020 to CY2022 from 60-Day Comment Period_508.pdf	10/13/2021
Appendix E: Crosswalk	Crosswalk of Changes from CY 2020 to CY 2022 - Appendix E_060721.pdf	10/13/2021
DV Manual: Crosswalk	Crosswalk of Changes from CY 2020 to CY 2022 - DV Manual_060721.pdf	10/13/2021

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