View Information Collection (IC)

View Information Collection (IC)

CY 2012-Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EGWP
 
No Modified
 
Mandatory
 
42 CFR 423.514 42 CFR 423.440 42 CFR 423.153 42 CFR 423.112 42 CFR 423.120 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_PACE_Plan 2012_Application_for_New_PACE_Plan.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10137 2013 Application for New Cost Plan 2013 Application for New Cost Plan.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10137 2013 Application for New Prescription Drug Plan (PDP) 2013 Application for New Prescription Drug Plan (PDP)_clean_30day.pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10137 2013 Application for PDP and MA-PD Service Area Expansion 2013 Application for PDP and MA-PD Service Area Expansion (SAE).pdf Yes Yes Fillable Fileable
Form and Instruction CMS-10137 2013 New Medicare Advantage Prescription Drug Plan (MA-PD 2013 New Medicare Advantage Prescription Drug Plan (MA-PD).pdf Yes Yes Fillable Fileable

Health Health Care Services

 

178 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 178 0 -234 117 0 295
Annual IC Time Burden (Hours) 2,322 0 178 -1,432 0 3,576
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.