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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 422.516(a)(3),(a)(4),(a)(6)
42 CFR 423.514 (a)(3) (a) (4) (a) (6)
42 CFR 423.514 (a)(1) (a) (2)
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
CY 2023 DV Appendix B_20221014_508.pdf
Yes
No
Printable Only
Instruction
CY 2023 DV_DV Procedure Manual_20221014.pdf
Yes
No
Fillable Printable
Form and Instruction
CMS-10305
Organizational Assessment Instrument
CY 2023 DV_Appendix E_20221014_508.pdf
Yes
Yes
Fillable Printable
Form and Instruction
CMS-10305
Grievances (Part C)_2022
CY 2023 DV Appendix J_C-Grievances_20221014_508.pdf
Yes
Yes
Fillable Printable
Form and Instruction
CMS-10305
Grievances (Part D) _2022
CY 2023 DV Appendix J_D-Grievances_20221014_508.pdf
Yes
Yes
Fillable Printable
Form and Instruction
CMS-10305
Coverage Determinations and Redeterminations (Part D) 2022
CY 2023 DV Appendix J_CDR_20221014_508.pdf
Yes
Yes
Fillable Printable
Form and Instruction
CMS-10305
Improving Drug Utilization Review Controls (Part D) 2022
CY 2023 DV Appendix J_DUR_20221014_508.pdf
Yes
Yes
Fillable Printable
Form and Instruction
CMS-10305
Medication Therapy Management (MTM) Programs (Part D) 2022
CY 2023 DV Appendix J_MTM_20221014_508.pdf
Yes
Yes
Fillable Printable
Form and Instruction
CMS-10305
Organization Determinations/Reconsiderations (Part C) 2022
CY 2023 DV Appendix J_ODR_20221014_508.pdf
Yes
Yes
Fillable Printable
Form and Instruction
CMS-10305
Special Needs Plans (SNPs) Care Management 2022
CY 2023 DV Appendix J_SNP_20221014_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:
793
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
793
0
0
32
0
761
Annual IC Time Burden (Hours)
21,535
0
0
589
0
20,946
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Appendix B Crosswalk
CY2022 to CY2023 DV Appendix B Crosswalk of Changes_Draft_20220714.pdf
08/04/2022
Appendix J Crosswalk
CY2022 to CY2023 DV Appendix J Crosswalk of Changes_Draft_20220714.pdf
08/04/2022
Appendix E: Crosswalk
Crosswalk of Changes from CY2022 to CY2023_App E_Draft_20220310_508.pdf
08/04/2022
Appendix B DV Crosswalk_Post 30-Day
CY2022 to CY2023 Appendix B DV Crosswalk_Post 30-Day PRA_20221014_508.pdf
10/25/2022
Appendix J DV Crosswalk_Post 30-Day
CY2022 to CY2023 Appendix J DV Crosswalk_Post 30-Day PRA_20221014_508.pdf
10/25/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.