Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
CY2023 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262) Modified 8770 55782 0 Form and Instruction CMS-R-262 MTM2025 Mockup
Form and Instruction CMS-R-262 Benefit Details-Service Categories 1-10
Form and Instruction CMS-R-262 Benefit Details-Service Categories 11-20
Form and Instruction CMS-R-262 Cost Share Groups
Form and Instruction CMS-R-262 General Setup
Form and Instruction CMS-R-262 Section Rx
Form and Instruction CMS-R-262 VBID Rx
Form and Instruction CMS-R-262 VBID-UF-SSBCI Packages
Total burden requested under this ICR: 8770 55782 0  
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