Information Collection

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

IC 194762 under ICR 202402-0938-012 · OMB 0938-1115.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CY 2023 DV Appendix B_20221014_508.pdf	Instruction
CY 2023 DV Appendix B_20221014_508.pdf	Instruction
CY 2025 DV_Procedure_Manual_20240220_DRAFT_508.pdf	Instruction
CY 2025 DV_Procedure_Manual_20240220_DRAFT_508.pdf	Instruction
CMS-10305 Organizational Assessment Instrument CY 2025 DV_Appendix E_20240220_508_DRAFT_clean_508.pdf	Form and Instruction
CMS-10305 Organizational Assessment Instrument CY 2025 DV_Appendix E_20240220_508_DRAFT_clean_508.pdf	Form and Instruction

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)(3) (a) (4) (a) (6) 42 CFR 422.516(a)(3),(a)(4),(a)(6) 42 CFR 423.514 (a)(1) (a) (2) 42 CFR 422.516_(a)(1),(a)(2)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			CY 2023 DV Appendix B_20221014_508.pdf	Yes	No	Printable Only
Instruction			CY 2025 DV_Procedure_Manual_20240220_DRAFT_508.pdf	Yes	No	Fillable Printable
Form and Instruction	CMS-10305	Organizational Assessment Instrument	CY 2025 DV_Appendix E_20240220_508_DRAFT_clean_508.pdf	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 809

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	809	809
Annual IC Time Burden (Hours)	10,500	10,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.