Information Collection

Medicare Part C UM Audits

IC 273408 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 Audits	Form and Instruction
Analysis of Internal Coverage Criteria.xlsx	Instruction
CMS-10913 CMS List of Targeted Services CMS List of Targeted Services.docx	Form and Instruction
CMS-10913 Medicare PartC UM Audit Protocol Data Request Medicare PartC_UM_AuditProtocolDataRequest.docx	Form and Instruction
CMS-10913 Utilization Management Criteria (UMC) Record Layout with Utilization Management Criteria (UMC) Record Layout with Examples.xlsx	Form and Instruction
CMS-10913 UMSupplementalQuestions UMSupplementalQuestions.xlsx	Form and Instruction
CMS-10913 Medicare Part C UM Root Cause Analysis Medicare Part C UM Root Cause Analysis.xlsx	Form and Instruction

IC Title:

Agency IC Tracking Number:

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Obligation to Respond:

CFR Citation:

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

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Privacy Act System of Records

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Percentage of Respondents Reporting Electronically:

table that charts list of burden
		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
Annual IC Time Burden (Hours)
Annual IC Cost Burden (Dollars)

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.

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