Information Collection

Medicare Part C UM Annual Data Submission

IC 273407 under ICR 202412-0938-017 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10913 Medicare Part C UM Annual Data Submission	Form and Instruction
Form CMS-10913 Medicare PartC_UM_Annual Data Submission Medicare Part C UM Annual Data Submission	Form and Instruction
Form CMS-10913 Utilization Management Annual Submission (UMAS) Record Layout with Examples Medicare Part C UM Annual Data Submission	Form and Instruction
CMS-10913 Medicare PartC_UM_Annual Data Submission Medicare PartC_UM_AnnualDataSubmission.docx	Form and Instruction
CMS-10913 Medicare PartC_UM_Annual Data Submission Medicare PartC_UM_AnnualDataSubmission.docx	Form and Instruction
CMS-10913 Utilization Management Annual Submission (UMAS) Record L Utilization Management Annual Submission (UMAS) Record Layout with Examples.xlsx	Form and Instruction
CMS-10913 Utilization Management Annual Submission (UMAS) Record L Utilization Management Annual Submission (UMAS) Record Layout with Examples.xlsx	Form and Instruction
Medicare PartC_UM_AnnualDataSubmission_track changes.pdf Track Change - Medicare Part C UM Annual Data Submission	IC Document
Utilization Management Annual Submission (UMAS) Record Layout with Examples_track changes.pdf Track Change - UMAS Record Layout	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422 Section 137 42 CFR 422 Section 101 42 CFR 442 Section 516(a)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10913				Yes	Yes	Fillable Printable
Form and Instruction	CMS-10913				Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 175

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	175	175
Annual IC Time Burden (Hours)	2,625	2,625
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Track Change - Medicare Part C UM Annual Data Submission		09/22/2025
Track Change - UMAS Record Layout		09/22/2025

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

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