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View Information Collection (IC)

CY2013 Plan Benefit Package (PBP) Software and Formulary Submission - CMS-R-262
 
No Modified
 
Required to Obtain or Retain Benefits
 
42 CFR 422.250 42 CFR 422.252 42 CFR 422.254 42 CFR 422.256 42 CFR 422.258 42 CFR 422.262 42 CFR 422.264 42 CFR 422.266 42 CFR 422.270 42 CFR 422.300 42 CFR 422.304 42 CFR 422.306 42 CFR 422.308 42 CFR 422.310 42 CFR 422.312 42 CFR 422.314 42 CFR 422.316 42 CFR 422.318 42 CFR 422.320 42 CFR 422.322 42 CFR 422.324 42 CFR 423.251 42 CFR 423.258 42 CFR 423.265 42 CFR 423.272 42 CFR 423.286 42 CFR 423.293 42 CFR 423.301 42 CFR 423.308 42 CFR 423.315 42 CFR 423.322 42 CFR 423.329 42 CFR 423.336 42 CFR 423.343 42 CFR 423.346 42 CFR 423.350

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-MTMP - Fees Page Mockup Yes Yes Fillable Fileable
Other-MTMP - Resources Page Mockup Yes Yes Fillable Fileable
Other-Review Tool Page Mockup Yes Yes Fillable Fileable
Other-MTMP -Verification Page Mockup Yes Yes Fillable Fileable
Other-Plan ADD File Record Layout Yes Yes Fillable Fileable
Other-Plan Excluded Drugs Record Layout Yes Yes Fillable Fileable
Other-Plan Gap Coverage File Layout Yes Yes Fillable Fileable
Other-Plan Formulary Submission File Record Layout Yes Yes Fillable Fileable
Other-Plan Free First Fill File Record Layout Yes Yes Fillable Fileable
Other-Plan Home Infusion File Layout Yes Yes Fillable Fileable
Other-Plan Over The Counter File Record Yes Yes Fillable Fileable
Other-Plan Prior Authorization Record Layout Yes Yes Fillable Fileable
Other-Plan Step Therapy Record Layout Yes Yes Fillable Fileable
Other-Appendix_C_PBP 2014 screenshots_section Yes Yes Fillable Fileable
Other-Appendix_C_PBP 2014 screenshots_section_b Yes Yes Fillable Fileable
Other-Appendix_C_PBP_2014 screenshots _section_d Yes Yes Fillable Fileable
Other-Appendix_C_PBP 2014 screenshots_section_c Yes Yes Fillable Fileable
Other-Appendix_C_PBP_2014 screenshots_section_a Yes Yes Fillable Fileable

Health Health Care Services

 

641 25
   
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 6,070 0 0 57 0 6,013
Annual IC Time Burden (Hours) 56,710 0 0 3,593 0 53,117
Annual IC Cost Burden (Dollars) 4,366,651 0 0 263,225 0 4,103,426

Title Document Date Uploaded
List of Changes 01/18/2013
Appendix_D_ MMAFinalTitleIFederalRegister 01/18/2013
Appendix_D_ MMAFinalTitleIIFederalRegister 01/18/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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