View Information Collection (IC)

View Information Collection (IC)

Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG
 
No Modified
 
Voluntary
 
42 CFR 423.112 42 CFR 423.440 42 CFR 423.153 42 CFR 423.120 42 CFR 423.514 42 CFR 423.512

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10137 Application for New PDP CMS-10137 2008pdpappdraft110606 clean version.doc Yes Yes Paper Only
Form and Instruction CMS-10137 SAE Application CMS-10137 Clean SAEApp2008_110706.doc Yes Yes Paper Only
Form and Instruction CMS-10137 Application for New Cost Plan CMS-10137 CostPlanPartDApp2008_110606cleanversion.DOC Yes Yes Paper Only
Form and Instruction CMS-10137 EPOG Application for EPOG CMS-10137-EPOG DRAFT_2008_DirectMAPDApplication.clean.DOC Yes Yes Paper Only
Form and Instruction CMS-10137 Application for New Employer CMS-10137 EPOG DRAFT_2008_DirectPDPApplication.clean.doc Yes Yes Paper Only
Form and Instruction CMS-10137 Application for New MA-PD CMS-10137 MAPDPartDApp2008_110606clean version.DOC Yes Yes Paper Only
Form and Instruction CMS-10137 EPOG Application for New EPOG PDP CMS-10137-EPOG Draft_EGWP New PDP_app_11.08.06.clean.doc Yes Yes Paper Only
Form and Instruction CMS-10137 EPOG Application for Existing PDP CMS-10137-EPOG Draft_EGWP_Existing PDP_app_11.08.06.clean.doc Yes Yes Paper Only
Form and Instruction CMS-10137 EPOG Application for EPOG Cost Plans CMS-10137-EPOG EGWPCost_DRAFT 11.08.06.clean.doc Yes Yes Paper Only
Form and Instruction CMS-10137 SAE Application DraftSAEApp2008_120806.doc Yes Yes Paper Only
Form and Instruction CMS-10137 Application for New PDP Draft2008pdpapp120706.doc Yes Yes Paper Only
Form and Instruction CMS-10137 Application for New MA-PD DraftMAPDPartDApp2008_120706 (2).doc Yes Yes Paper Only
Form and Instruction CMS-10137 Application for New Cost Plan DraftCostPlanPartDApp2008_120706 (2).doc Yes Yes Paper Only

Health Health Care Services

 

216 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  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 216 115 0 0 0 101
Annual IC Time Burden (Hours) 5,316 1,488 0 0 0 3,828
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.