View Information Collection (IC)
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Medicare Parts C and D Universal Audit Guide
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
42 CFR 422.504
42 CFR 423.505
42 CFR 423.514
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Instruction
Medicare_Part_C__Part_D_Universal_Audit_Guide_07_10_13 CLEAN--REDUCED [rev 11-13-2013 by OSORA PRA].pdf
Yes
No
Printable Only
Instruction
Attachment X - OEV Protocol Audit Process and Universe Request--REDUCED.pdf
Yes
No
Printable Only
Other-Template - OEV Universe
Attachment X - A - OEV Universe Template--REDUCED.pdf
Yes
Yes
Printable Only
Instruction
Attachment VIII - 2013 Audit Process Document--REDUCED.pdf
Yes
No
Printable Only
Other-Template - ODAG Universe
Attachment VII-A - ODAG Universe Template --REDUCED.pdf
Yes
Yes
Fillable Printable
Instruction
Attachment VII ODAG Audit Process and Universe Request--REDUCED.pdf
Yes
No
Printable Only
Form
CMS-10191
Self Disclosure Report
Attachment VI -Self Disclosure Report--REDUCED.pdf
Yes
Yes
Fillable Printable
Instruction
Attachment I-B - FA Sample Case Minimum Documentation Required--REDUCED.pdf
Yes
No
Printable Only
Instruction
Attachment IX - SNP MOC Audit Process and Universe Request--REDUCED.pdf
Yes
No
Printable Only
Other-Template - CDAG Universe
Attachment II-A - CDAG Universe Template--REDUCED.pdf
Yes
Yes
Printable Only
Instruction
Attachment II - CDAG Audit Process and Universe Request--REDUCED.pdf
Yes
No
Printable Only
Other-Template - FA Universe
Attachment I-A - FA Universe Template--REDUCED.pdf
Yes
Yes
Printable Only
Instruction
Attachment I - FA Audit Process and Universe Request--REDUCED.pdf
Yes
No
Printable Only
Other-Template - SNP MOC Universe
Att IX-A - SNP MOC Universe Template--REDUCED.pdf
Yes
Yes
Printable Only
Form
CMS-10191
CPE SELF-ASSESSMENT QUESTIONNAIRE
5-2013 12-21-12-Attachment V - CPE Self-Assessment Questionnaire--REDUCED.pdf
Yes
Yes
Fillable Printable
Other-template - Organizational Structure and Governance
4-2013 12-21-12-Attachment IV Organization Governance Template--REDUCED.pdf
Yes
No
Printable Only
Form
CMS-10191
Key Contacts for Compliance Program Operations
3-2013 12-21-12-Attachment III-B Compliance Program Contacts--REDUCED.pdf
Yes
Yes
Fillable Printable
Instruction
2-2013 12-21-12-Attachment III-A Sample Case File Documentation--REDUCED.pdf
Yes
No
Printable Only
Instruction
2.13.13 - 2013 CPE Attachment III -Data and Document Request [rev 7-21-13 by OSORA PRA]--REDUCED.pdf
Yes
No
Printable 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:
195
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
90 %
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
195
0
0
0
195
0
Annual IC Time Burden (Hours)
23,595
0
0
-585
24,180
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
PRA - Crosswalk - Protocol 2012- 2013 changes v2--REDUCED
PRA - Crosswalk - Protocol 2012- 2013 changes v2--REDUCED.PDF
07/24/2013
PRA - Crosswalk - Engagement Letter CLEAN 7_9_13--REDUCED
PRA - Crosswalk - Engagement Letter CLEAN 7_9_13--REDUCED.pdf
07/24/2013
PRA - Crosswalk - Universal Audit Guide _07_02_13--REDUCED
PRA - Crosswalk - Universal Audit Guide _07_02_13--REDUCED.pdf
07/24/2013
PRA - Crosswalk - Auidt Process CLEAN 7_10_13--REDUCED
PRA - Crosswalk - Auidt Process CLEAN 7_10_13--REDUCED.pdf
07/24/2013
Engagement Letter/Start Notice
Appendix P - Engagement Letter_Start Notice-REDUCED.pdf
07/24/2013
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.