IDI Discussion Guide

Medicare Plan Performance Warning Information (CMS-10836)

OMB: 0938-1456

IC ID: 259113

Information Collection (IC) Details

View Information Collection (IC)

IDI Discussion Guide
 
No New
 
Voluntary
 
42 CFR 422.152

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10836 Audits and Letters - Beneficiaries and Caregivers Plan Performance Warning - C - Guide 1 (Beneficiary) Audits and Letters_112022.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10836 Audits and Letters - Intermediaries Plan Performance Warning - D - Guide 1 (Intermediaries) Audits and Letters_112022.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10836 Enforcement and Compliance Information - Beneficiaries Plan Performance Warning - E - Guide 2 (Beneficiaries) Enforcement and Compliance Information_112022.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10836 Enforcement and Compliance Information - Intermediaries Plan Performance Warning - F - Guide 2 (Intermediaries) Enforcement and Compliance Information_112022.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10836 Poor Plan Performance - Beneficiaries Plan Performance Warning - G - Guide 3 (Beneficiaries) Poor Plan Performance_112022.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10836 Poor Plan Performance - Intemediaries Plan Performance Warning - H - Guide 3 (Intermediaries) Poor Plan Performance_112022.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

288 0
   
Individuals or Households
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 288 0 0 288 0 0
Annual IC Time Burden (Hours) 432 0 0 432 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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