Program Audits

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

OMB: 0938-1395

IC ID: 242155

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Form
Form
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form
Form
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Program Audits
 
No Modified
 
Mandatory
 
42 CFR 423.514 42 CFR 422.504 42 CFR 423.505

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction CPEProtocol.pdf Yes Yes Printable Only
Instruction FAProtocol.pdf Yes Yes Printable Only
Instruction CDAGProtocol.pdf Yes Yes Printable Only
Instruction ODAGProtocol.pdf Yes Yes Printable Only
Instruction SNPCCProtocol.pdf Yes Yes Printable Only
Form CMS-10717 Pre Audit Issue Summary PreAuditIssueSummary.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10717 CPE Compliance Officer Questionnaire Compliance Officer Questionnaire (CO-Q) COQuestionnaire.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10717 Part D Formulary and Benefit Administration (FA) Supplemental Questionnaire FASupplementalQuestionnaire.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10717 First Tier, Downstream, and Related Entities Operations Oversight Questionnaire FDRQuestionnaire.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10717 Independent Validation Audit Work Plan IndependentValidation.pdf Yes Yes Fillable Printable
Instruction PowerPointPresentation.pdf Yes Yes Printable Only
Form CMS-10717 Root Cause Analysis RootCauseAnalysis.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10717 Special Needs Plans - Care Coordination Supplemental Questionnaire SNPCCQuestionnaire.pdf Yes Yes Fillable Printable
Form and Instruction CMS-10717 Attendance Log for Meetings/Webinars/Conferences AttendanceLogTemplate.pdf Yes Yes Fillable Printable

Health Health Care Services

 

25 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Approved 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 25 0 0 0 0 25
Annual IC Time Burden (Hours) 17,525 0 0 0 0 17,525
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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