View Information Collection (IC)
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 EGWP
 
No Modified
 
Mandatory
 
42 CFR 423.440 42 CFR 423.153 42 CFR 423.112 42 CFR 423.120 42 CFR 423.512 42 CFR 423.514

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10137 PACE Yes Yes Paper Only
Form and Instruction CMS-10137 COST Yes Yes Paper Only
Form and Instruction CMS-10137 MAPD Yes Yes Paper Only
Form and Instruction CMS-10137 PDP Yes Yes Paper Only
Form and Instruction CMS-10137 SAE Yes Yes Paper Only
Other-redline Yes Yes Paper Only
Other-redline Yes Yes Paper Only
Other-redline Yes Yes Paper Only
Other-redline No   Paper Only
Other-redline No   Paper Only
Form and Instruction CMS-10137 Employer Union MAPD Yes Yes Paper Only
Form and Instruction CMS-10137 Employer Union PDP Yes Yes Paper Only
Form and Instruction CMS-10137 EGWP COST Yes Yes Paper Only
Form and Instruction CMS-10137 EGWP PDP Yes Yes Paper Only
Other-redline Yes Yes Paper Only
Other-redline Yes Yes Paper Only
Other-redline Yes Yes Paper Only
Other-redline Yes Yes Paper Only

Health Health Care Services

 

455 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   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 455 0 -402 0 0 857
Annual IC Time Burden (Hours) 11,890 0 -16,232 0 0 28,122
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS-10137 High level Summ_2009_Application_Revisions_092807 10/10/2007
CMS-10137 EPOG Part D Applications_High level summary of changes_Final 10/10/2007
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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