View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Program Audits
 
No Modified
 
Mandatory
 
42 CFR 423.514 42 CFR 422.504 42 CFR 423.505

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Yes Yes Printable Only
Instruction Yes Yes Printable Only
Instruction Yes Yes Printable Only
Instruction Yes Yes Printable Only
Instruction Yes Yes Printable Only
Form CMS-10717 Yes Yes Fillable Printable
Form and Instruction CMS-10717 Yes Yes Fillable Printable
Form and Instruction CMS-10717 Yes Yes Fillable Printable
Form and Instruction CMS-10717 Yes Yes Fillable Printable
Form and Instruction CMS-10717 Yes Yes Fillable Printable
Form and Instruction CMS-10717 Yes Yes Fillable Printable
Form and Instruction CMS-10717 Yes Yes Fillable Printable
Form and Instruction CMS-10717 Yes Yes Fillable Printable
Form and Instruction CMS-10717 Yes Yes Fillable Printable
Form and Instruction CMS-10717 Yes Yes Fillable Printable
Form and Instruction CMS-10717 Yes Yes Fillable Printable
Form and Instruction CMS-10717 Yes Yes Fillable Fileable
Form and Instruction CMS-10717 Yes Yes Fillable Printable
Form and Instruction CMS-10717 Yes Yes Fillable Fileable
Form and Instruction CMS-10717 Yes Yes Fillable Fileable
Form CMS-10717 Yes Yes Fillable Fileable
Form and Instruction CMS-10717 Yes Yes Fillable Fileable
Form and Instruction CMS-10717 Yes Yes Fillable Fileable

Health Health Care Services

 

30 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 30 0 5 0 0 25
Annual IC Time Burden (Hours) 12,795 0 -4,730 0 0 17,525
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Formulary and Benefit Administration (FA) - Track change version 06/30/2026
Independent Validation Audit Work Plan - Track Change version 06/30/2026
Organization Determinations, Appeals, and Grievances - Track Change version 06/30/2026
Special Needs Plans Care Coordination - Track change 06/30/2026
Part C and Part D Compliance Program Effectiveness - Track change 06/30/2026
CDAG_Program Audit Protocol - Track Change 06/30/2026
CDAG_Processing of Coverage Requests Root Cause Analysis and Impact Analysi - Track Change 06/30/2026
CDAG_Root Cause Analysis and Impact Analysis - Track Change 06/30/2026
RootCauseAnalysis - Track Change 06/30/2026
Formulary and Benefits Administration (FA) Root Cause Analysis and Impact Analysis - Track Change 06/30/2026
ODAG_Processing of Coverage Requests Root Cause Analysis and Impact Analysis - Track Change 06/30/2026
ODAG_Root Cause Analysis and Impact Analysis - Track Change 06/30/2026
SNPCC-HRA-TMA - Track Change 06/30/2026
SNPCC-Root Cause Analysis and Impact Analysis - Track Change 06/30/2026
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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