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View Information Collection (IC)

View Information Collection (IC)

Medicare Part C UM Annual Data Submission
 
No New
 
Mandatory
 
42 CFR 422 Section 137 42 CFR 422 Section 101 42 CFR 442 Section 516(a)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10913 Medicare PartC_UM_Annual Data Submission Medicare PartC_UM_AnnualDataSubmission.docx Yes Yes Fillable Printable
Form and Instruction CMS-10913 Utilization Management Annual Submission (UMAS) Record Layout with Examples Utilization Management Annual Submission (UMAS) Record Layout with Examples.xlsx Yes Yes Fillable Printable

Health Health Care Services

 

175 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 175 0 175 0 0 0
Annual IC Time Burden (Hours) 2,625 0 2,625 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Track Change - Medicare Part C UM Annual Data Submission Medicare PartC_UM_AnnualDataSubmission_track changes.pdf 09/22/2025
Track Change - UMAS Record Layout Utilization Management Annual Submission (UMAS) Record Layout with Examples_track changes.pdf 09/22/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.