PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Program Audits
Modified
30
12795
0
Instruction
Instruction
Instruction
Instruction
Instruction
Form
CMS-10717
Pre Audit Issue Summary
Form and Instruction
CMS-10717
Compliance Program Effectiveness (CPE) Compliance Oversight Questionnaire
Form and Instruction
CMS-10717
Compliance Program Effectiveness (CPE) Customized Organizational Structure and Governance PowerPoint Presentation
Form and Instruction
CMS-10717
Part D Formulary and Benefit Administration (FA) Supplemental Questionnaire
Form and Instruction
CMS-10717
Special Needs Plans - Care Coordination Supplemental Questionnaire
Form and Instruction
CMS-10717
Part D Coverage Determinations, Appeals, and Grievances (CDAG) Processing of Coverage Requests Root Cause Analysis and Impact Analysis
Form and Instruction
CMS-10717
Part D Coverage Determinations, Appeals, and Grievances (CDAG) Classification of Requests Root Cause Analysis and Impact Analysis
Form and Instruction
CMS-10717
Special Needs Plans Care Coordination (SNPCC) Root Cause Analysis and Impact Analysis
Form and Instruction
CMS-10717
Special Needs Plans Care Coordination (SNPCC) HRA Timeliness Mitigation Analysis (HRA-TMA)
Form and Instruction
CMS-10717
Part C Organization Determinations, Appeals, and Grievances (ODAG) Processing of Coverage Requests Root Cause Analysis and Impact Analysis
Form and Instruction
CMS-10717
Part C Organization Determinations, Appeals, and Grievances (ODAG)Classification of Requests Root Cause Analysis and Impact Analysis
Form and Instruction
CMS-10717
Organization Determinations, Appeals, and Grievances (ODAG) ODAG Timeliness Mitigation Analysis (ODAG-TMA)
Form and Instruction
CMS-10717
Formulary and Benefits Administration (FA) Root Cause Analysis and Impact Analysis
Form and Instruction
CMS-10717
Root Cause Analysis
Form and Instruction
CMS-10717
Independent Validation Audit Work Plan
Form
CMS-10717
Attendance Log for Meetings/Webinars/Conferences
Form and Instruction
CMS-10717
CMS Request for Additional Information (RAI)/Sponsor Response
Form and Instruction
CMS-10717
Independent Validation Auditor (IVA) Validation Report
Yearly Industry-Wide Timeliness Monitoring Project (TMP)
Removed
0
0
0
Total burden requested under this ICR:
30
12795
0
To view an IC, click on IC Title
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