Medicare Part C and Part D Data Validation (42 C.F.R. 422.516g and 423.514g) - (CMS-10305)

Medicare Part C and Part D Data Validation (42 C.F.R. 422.516g and 423.514g)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1115 can be found here:

Documents and Forms

Document Name Document Type
App1DataValStandards (2).docx Instruction
App3DataExtractSamplInst.docx Instruction
App4_Instructions for FDCF.doc Instruction
CMS-10305 Appendix 2: Organizational Assessment Instrument App2OrgAssessmentInst1.docx Form and Instruction
CMS-10305 Appendix 5: Data Collection Form App5FdgsDataCollectForm.xlsx Form
Crosswalk.CMS_10305.xlsx Crosswalk IC Document

Information Collection (IC) Details

IC Title:	Medicare Part C and Part D Data Validation (42 C.F.R. 422.516g and 423.514g) - (CMS-10305)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.516_(a)(1),(a)(2) 42 CFR 422.516(a)(3),(a)(4),(a)(6) 42 CFR 423.514 (a)(1) (a) (2) 42 CFR 423.514 (a)(3) (a) (4) (a) (6)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			App1DataValStandards (2).docx	Yes	No	Printable Only
Form and Instruction	CMS-10305	Appendix 2: Organizational Assessment Instrument	App2OrgAssessmentInst1.docx	Yes	Yes	Fillable Printable
Instruction			App3DataExtractSamplInst.docx	Yes	No	Printable Only
Instruction			App4_Instructions for FDCF.doc	Yes	No	Printable Only
Form	CMS-10305	Appendix 5: Data Collection Form	App5FdgsDataCollectForm.xlsx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 657	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 Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	657	0	23	634
Annual IC Time Burden (Hours)	179,301	-55,802	-2,024	237,127
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk	Crosswalk.CMS_10305.xlsx	11/13/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.