Information Collection

Medicare Part C & D Improper Payment Measure (IPM) (CMS-10811)

IC 257138 under ICR 202211-0938-011 · OMB 0938-1185.

Documents and Forms

Document Name Document Type
Form CMS-10811 Medicare Part C & D Improper Payment Measure (IPM) (CMS-10811) Form and Instruction
CMS-10811 CMS-10811. Appendix A_Part C Survey Questions FINAL CMS-10811. Appendix A_Part C Survey Questions FINAL.pdf Form and Instruction
CMS-10811 CMS-10811. Appendix A_Part C Survey Questions FINAL CMS-10811. Appendix A_Part C Survey Questions FINAL.pdf Form and Instruction
CMS-10811 CMS-10811. Appendix B_Part D Survey Questions FINAL CMS-10811. Appendix B_Part D Survey Questions FINAL.pdf Form and Instruction
CMS-10811 CMS-10811. Appendix B_Part D Survey Questions FINAL CMS-10811. Appendix B_Part D Survey Questions FINAL.pdf Form and Instruction
CMS-10811. GenIC Template (Medicare Part C_D Fast Track).docx CMS-10811. GenIC Template (Medicare Part C_D Fast Track) IC Document
CMS-10811. GenIC Template (Medicare Part C_D Fast Track).docx CMS-10811. GenIC Template (Medicare Part C_D Fast Track) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medicare Part C & D Improper Payment Measure (IPM) (CMS-10811)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10811	CMS-10811. Appendix A_Part C Survey Questions FINAL	CMS-10811. Appendix A_Part C Survey Questions FINAL.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10811	CMS-10811. Appendix B_Part D Survey Questions FINAL	CMS-10811. Appendix B_Part D Survey Questions FINAL.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 900	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 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	900	900
Annual IC Time Burden (Hours)	45	45
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CMS-10811. GenIC Template (Medicare Part C_D Fast Track)	CMS-10811. GenIC Template (Medicare Part C_D Fast Track).docx	11/28/2022

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