Information Collection

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

IC 194762 under ICR 202610-0938-004 · OMB 0938-1115.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10305 Organizational Assessment Instrument (OAI) Medicare Part C and Part D Data Validation (42 CFR 422.516(g) and 423.514(g))	Form and Instruction
Form CMS-10305 Examination Engagement Standards (EES) Medicare Part C and Part D Data Validation (42 CFR 422.516(g) and 423.514(g))	Form and Instruction
2027 DV_Procedure Manual_20260817_508_Clean.docx	Instruction
CMS-10305 Organizational Assessment Instrument (OAI) 2027 DV_Appendix E OAI_20260817_508_Clean.docx	Form and Instruction
CMS-10305 Examination Engagement Standards (EES) 2027 DV_Appendix B EES_20260817_508_Clean.xlsx	Form and Instruction
2027 DV_Appendix E OAI_20260817_Redlined.pdf Organizational Assessment Instrument - Track change version	IC Document
2027 DV_Procedure Manual_20260817_Redlined.pdf Part C/D Reporting Requirements Data Validation Procedure Manual - Track Change version	IC Document
2027 DV_Appendix B EES_20260817_Redlined.pdf Examination Engagement Standards - Track change version	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 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) 42 CFR 423.514 (a)(3) (a) (4) (a) (6)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10305	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
	Requested	Previously Approved
Annual Number of Responses for this IC	840	840
Annual IC Time Burden (Hours)	10,920	10,920
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Organizational Assessment Instrument - Track change version		10/15/2026
Part C/D Reporting Requirements Data Validation Procedure Manual - Track Change version		10/15/2026
Examination Engagement Standards - Track change version		10/15/2026

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

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