Information Collection Request

Medicare Part C and Part D Program Audit and Industry-Wide Part C Timeliness Monitoring Project (TMP) Protocols (CMS-10717)

ICR 202310-0938-002 · OMB 0938-1395 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10717 Attendance Log for Meetings/Webinars/Conferences Form and Instruction Modified Available
Form CMS-10717 Special Needs Plans - Care Coordination Supplemental Questionnaire Form and Instruction Modified Available
Form CMS-10717 Root Cause Analysis Form Modified Available
Form CMS-10717 Independent Validation Audit Work Plan Form and Instruction Modified Available
Form CMS-10717 First Tier, Downstream, and Related Entities Operations Oversight Questionnaire Form and Instruction Modified Available
Form CMS-10717 Part D Formulary and Benefit Administration (FA) Supplemental Questionnaire Form and Instruction Modified Available
Form CMS-10717 CPE Compliance Officer Questionnaire Compliance Officer Questionnaire (CO-Q) Form and Instruction Modified Available
Form CMS-10717 Pre Audit Issue Summary Form Modified Available
CMS10717SupportingStatementA.docx Supporting Statement A Uploaded 2023-10-16 Repair queued
ResponsesToCommentsReceived60Day.pdf Supplementary Document Uploaded 2023-10-13 Available
10717Crosswalk.pdf Supplementary Document Uploaded 2023-10-13 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
242160 Yearly Industry-Wide Timeliness Monitoring Project (TMP) Modified
242155 Program Audits Form and Instruction ModifiedAttendance Log for Meetings/Webinars/Conferences
242155 Program Audits Form and Instruction ModifiedSpecial Needs Plans - Care Coordination Supplemental Questionnaire
242155 Program Audits Form ModifiedRoot Cause Analysis
242155 Program Audits Form and Instruction ModifiedIndependent Validation Audit Work Plan
242155 Program Audits Form and Instruction ModifiedFirst Tier, Downstream, and Related Entities Operations Oversight Questionnaire
242155 Program Audits Form and Instruction ModifiedPart D Formulary and Benefit Administration (FA) Supplemental Questionnaire
242155 Program Audits Form and Instruction ModifiedCPE Compliance Officer Questionnaire Compliance Officer Questionnaire (CO-Q)
242155 Program Audits Form ModifiedPre Audit Issue Summary
242155 Program Audits Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
01/31/2027 36 Months From Approved 05/31/2024
182 0 179
36,444 0 36,082
0 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Program Audits CMS-10717, CMS-10717, CMS-10717, CMS-10717, CMS-10717, CMS-10717, CMS-10717, CMS-10717 ,   ,   ,   ,   ,   ,   ,  
Yearly Industry-Wide Timeliness Monitoring Project (TMP)

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 182 179 0 0 3 0
Annual Time Burden (Hours) 36,444 36,082 0 0 362 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No