Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Medicare Parts C and D Program Audit Protocols and Data Requests Modified 241 52261 0 Form and Instruction CMS-10191 CPE Program Area Audit Process and Data Request
Form and Instruction CMS-10191 CPE Self-Assessment Questionnaire
Form and Instruction CMS-10191 CPE Compliance Officer Questionnaire
Form and Instruction CMS-10191 CPE Audit Organizational Structure and Governance PPT Template
Form and Instruction CMS-10191 Accountability for Oversight of First-Tier, Downstream and Related Entities Questionnaire
Form and Instruction CMS-10191 SIU/FWA Prevention and Detection Questionnaire
Form and Instruction CMS-10191 FA AUDIT PROCESS AND DATA REQUEST
Form and Instruction CMS-10191 CDAG AUDIT PROCESS AND DATA REQUEST
Form CMS-10191 CDAG Supplemental Questions
Form and Instruction CMS-10191 ODAG AUDIT PROCESS AND DATA REQUEST
Form CMS-10191 ODAG Supplemental Questions
Form and Instruction CMS-10191 SNP-MOC AUDIT PROCESS AND DATA REQUEST
Form and Instruction CMS-10191 MTM PILOT AUDIT PROCESS AND DATA REQUEST
Form CMS-10191 CDAG CDM Impact Analysis
Form CMS-10191 CDAG GRV Impact Analysis
Form CMS-10191 FA Impact Analysis
Form CMS10191 MTM Impact Analysis
Form CMS-10191 ODAG CDM Impact Analysis
Form CMS-10191 ODAG DIS Impact Analysis
Form CMS-10191 ODAG GRV Impact Analysis
Form CMS-10191 ODAG PMNT Impact Analysis
Form CMS-10191 SNP-MOC ICP ICT Impact Analysis
Form CMS-10191 SNP-MOC Impact Analysis
Form CMS-10191 SNP-MOC Training Impact Analysis
Form CMS-10191 Pre-Audit Issues Summary
Total burden requested under this ICR: 241 52261 0  
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