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Federal forms, ICRs, and supporting documents

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.

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

View Information Collection (IC)

Medicare Part C and Part D Data Validation (42 CFR 422.516(g) and 423.514(g))
 
No Modified
 
Mandatory
 
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)

Document Type Form No. Form Name Instrument File URL 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

Health Health Care Services

 

809 0
   
Private Sector Businesses or other for-profits
 
   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 809 0 0 0 0 809
Annual IC Time Burden (Hours) 10,500 0 0 0 0 10,500
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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