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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Part C Medicare Advantage Reporting Requirements and Supporting Regulations in 42 CFR 422.516 (a) - (CMS-10261)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Mandatory
CFR Citation:
42 CFR 422.516(a)(1)
42 CFR 422.516(a)(2)
42 CFR 422.516(a)(3)
42 CFR 422.516(a)(4)
42 CFR 422.516(a)(6)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
CMS-10261
Attachment I - Part C Reporting Overview
Attachment I.9.23.08.doc
Yes
Yes
Paper Only
Form
CMS-10261
Attachment III - Medicare Advantage Medical Utilization and Expenditure Experience
Attachment III-9-22-08.xls
No
No
Paper Only
Form and Instruction
CMS-10261
Medicare Part C Reporting Requirements
Attachment II Part C Reporting Overview 9 25 08.doc
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
718
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
100 %
Approved
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
12,709
0
12,709
0
0
0
Annual IC Time Burden (Hours)
286,944
22,073
264,871
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Summary of Revisions-9-25-08
Summary of Revisions-9-25-08.doc
09/26/2008
Attachment IV
Attachment IV.Part C _9.22.08.doc
09/26/2008
Attachment V_PartC_09
Attachment V_PartC_09.22.08.doc
09/26/2008
TRK-Attachment I
TRK-Attachment I.changes.9.23.08.doc
09/26/2008
TRK-Attachment II changes
TRK-Attachment II changes.09-22-08.doc
09/26/2008
TRK-Attachment III-changes
TRK-Attachment III-changes.xls
09/26/2008
further attachment I changes
Attachment_I.changes.doc
12/23/2008
further attachment II changes
Attachment_II.changes.doc
12/23/2008
further attachment III changes
Attachment_III_Changes.xls
12/23/2008
response to comments
Comments_OMB_TRACKING_11_05_08.doc
12/23/2008
Crosswalk_Revisions
Crosswalk_Revisions.doc
12/23/2008
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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