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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-0936
ICR Reference No:
200809-0938-013
Status:
Historical Active
Previous ICR Reference No:
200710-0938-005
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Applications for Medicare Part D plans: PDP Plans, MA-PD Plans, Cost Plans, PACE organizations, SAE and EGWP
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Emergency
Approval Requested By:
12/12/2008
OIRA Conclusion Action:
Approved with change
Conclusion Date:
12/12/2008
Retrieve Notice of Action (NOA)
Date Received in OIRA:
09/18/2008
Terms of Clearance:
This ICR is approved consistent with revisions in response to public comments. Previous terms of clearance remain in effect.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2009
6 Months From Approved
01/31/2011
Responses
455
0
455
Time Burden (Hours)
11,890
0
11,890
Cost Burden (Dollars)
0
0
0
Abstract:
The Applications for Part D sponsors to offer qualified prescription drug coverage are completed by entities seeking approval to offer Part D benefits under the Medicare Prescription Drug Benefit program established by section 101 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and is codified in section 1860D of the Social Security Act (the Act).
Emergency Justfication:
See attached emergency justification document. This field only has a 200 max character limit, not 4000 as noted; consequently, the emergency justification is attached as a separate document.
Authorizing Statute(s):
PL:
Pub.L. 108 - 173 1860D
Name of Law: Medicare Prescription Drug Benefit Program
Statute at Large:
18 Stat. 1860
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
0938-AP52
Final or interim final rulemaking
73 FR 54226
09/18/2008
Federal Register Notices & Comments
30-day Notice:
Federal Register Citation:
Citation Date:
73 FR 54160
09/18/2008
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EGWP
CMS-10137, CMS-10137, CMS-10137, CMS-10137, CMS-10137, CMS-10137, CMS-10137, CMS-10137, CMS-10137
Solicitation for Applications for New Employer/Union Direct Contract Medicare Advantage Prescription Drug Plan (MA-PD) Sponsors
,
2010 Solicitation for Applications for New Employer/Union Direct Contract Prescription Drug Plan (PDP) Sponsors
,
Application Instructions for Cost Plan Sponsors to Offer New Employer/Union-Only Group Waiver Plans (EGWPs)
,
2010 Application Instructions for PDP Sponsors to Offer New Employer/Union-Only Group Waiver Plans (EGWPs)
,
Medicare Part D Application for New PACE Organizations
,
Solicitation for Applications for New Cost Plan Sponsors Contract Year 2010
,
Solicitation for Applications for New Medicare Advantage Prescription Drug Plan (MA-PD) Sponsors
,
Solicitation for Applications for New Prescription Drug Plans (PDP) Sponsors
,
2010 PART D SERVICE AREA EXPANSION APPLICATION
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
455
455
0
0
0
0
Annual Time Burden (Hours)
11,890
11,890
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$100,800
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
Uncollected
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Bonnie Harkless 4107865666
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
09/18/2008
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