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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Medicare Part C and Part D Data Validation (42 CFR 422.516(g) and 423.514(g))
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
42 CFR 423.514 (a)(1) (a) (2)
42 CFR 422.516(a)(3),(a)(4),(a)(6)
42 CFR 423.514 (a)(3) (a) (4) (a) (6)
42 CFR 422.516_(a)(1),(a)(2)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Instruction
2022 DV_Appendix B DataValidationStandards_508_20211215.pdf
Yes
No
Printable Only
Instruction
2022 DV_DV Procedure Manual_508_20211215.pdf
Yes
No
Fillable Printable
Form and Instruction
CMS-10305
Appendix J_FDCF
Appendix J_FDCF_Final_06022021_508.xlsx
Yes
No
Fillable Printable
Form and Instruction
CMS-10305
Organizational Assessment Instrument
Appendix E Organizational Assessment Instrument_06042021_508.pdf
Yes
Yes
Fillable Printable
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:
761
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
761
0
208
0
0
553
Annual IC Time Burden (Hours)
20,946
0
5,614
0
0
15,332
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Appendix B Crosswalk
Appendix B Crosswalk of Changes from CY2020 to CY2022 from 60-Day Comment Period_508.pdf
10/13/2021
Appendix J Crosswalk
Appendix J Crosswalk of Changes from CY2020 to CY2022 from 60-Day Comment Period_508.pdf
10/13/2021
Appendix E: Crosswalk
Crosswalk of Changes from CY 2020 to CY 2022 - Appendix E_060721.pdf
10/13/2021
DV Manual: Crosswalk
Crosswalk of Changes from CY 2020 to CY 2022 - DV Manual_060721.pdf
10/13/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.