Information Collection

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

IC 194762 under ICR 202504-0938-014 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form CMS-10305 Organizational Assessment Instrument Medicare Part C and Part D Data Validation (42 CFR 422.516(g) and 423.514(g))	Form and Instruction
CY 2026 DV_Appendix E_.docx	Instruction
CY 2026 DV_Appendix E_.docx	Instruction
CY 2026 DV_Procedure_Manual_.docx	Instruction
CY 2026 DV_Procedure_Manual_.docx	Instruction
CMS-10305 Organizational Assessment Instrument CY 2026 DV_EES_FINAL_.xlsx	Form and Instruction
CMS-10305 Organizational Assessment Instrument CY 2026 DV_EES_FINAL_.xlsx	Form and Instruction
CY 2026 DV_Appendix E_DRAFT_Redlined.pdf DV_Appendix E - Track Change	IC Document
CY 2026 DV_Appendix E_DRAFT_Redlined.pdf DV_Appendix E - Track Change	IC Document
CY 2026 DV_Procedure_Manual_DRAFT_Redlined.pdf DV_Procedure_Manual - Track Change	IC Document
CY 2026 DV_Procedure_Manual_DRAFT_Redlined.pdf DV_Procedure_Manual - Track Change	IC Document
CY 2026 DV_EES_20250211_DRAFT_Redlined.xlsx 2026 DV_EES- Excel Track Change	IC Document
CY 2026 DV_EES_20250211_DRAFT_Redlined.xlsx 2026 DV_EES- Excel Track Change	IC Document

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction		Yes	No	Printable Only
Instruction		Yes	No	Fillable Printable
Form and Instruction	CMS-10305	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 840

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	840	31	809
Annual IC Time Burden (Hours)	10,920	420	10,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
DV_Appendix E - Track Change		04/23/2025
DV_Procedure_Manual - Track Change		04/23/2025
2026 DV_EES- Excel Track Change		04/15/2025

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

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