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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 Medicare Part D Application for New PACE Organizations 2009 Contract Year 2009 PACE Part D Application_final_1205.doc Yes Yes Paper Only
Form and Instruction CMS-10137 COST Solicitation for Applications for New Cost Plan Sponsors Contract Year 2009 2009 Part D Cost_final_1205.DOC Yes Yes Paper Only
Form and Instruction CMS-10137 MAPD Solicitation for Applications for New Medicare Advantage Prescription Drug Plan (MA-PD) Sponsors 2009 Contract Year 2009 Part D MAPD_final_1205.doc Yes Yes Paper Only
Form and Instruction CMS-10137 PDP Solicitation for Applications for New Prescription Drug Plans (PDP) Sponsors 2009 Contract Year 2009 Part D PDP_final_1205.doc Yes Yes Paper Only
Form and Instruction CMS-10137 SAE 2009 PART D SERVICE AREA EXPANSION APPLICATION for PRESCRIPTION DRUG PLAN (PDP) SPONSORS and MEDICARE ADVANTAGE PRESCRIPTION DRUG PLAN MEDICARE ADVANTAGE PRESCRIPTION DRUG PLAN contract year 2009 2009 Part D SAE_final_1205.doc Yes Yes Paper Only
Other-redline redline2009 PACE Part D Applicationdraft1205.doc Yes Yes Paper Only
Other-redline redline2009cost_draft1205.DOC Yes Yes Paper Only
Other-redline redline2009mapd_draft1205.doc Yes Yes Paper Only
Other-redline redline 2009pdp_draft1205.doc No   Paper Only
Other-redline redline2009SAE_draft1205.doc No   Paper Only
Form and Instruction CMS-10137 Employer Union MAPD 2009 Solicitation for Applications for New Employer/Union Direct Contract Medicare Advantage Prescription Drug Plan (MA-PD) Sponcors 2009 Direct Contract MA-PD Application_FINAL.doc Yes Yes Paper Only
Form and Instruction CMS-10137 Employer Union PDP 2009 Solicitation for Applications for New Employer/Union Direct Contract Prescription Drug Plan (PDP) Sponsors 2009 Direct Contract PDP Application_FINAL.doc Yes Yes Paper Only
Form and Instruction CMS-10137 EGWP COST 2009 Application Instructions for Cost Plan Sponsors to Offer New Employer/Union-Only Group Waiver Plans (EGWPs) 2009 EGWP Cost Application_Final.doc Yes Yes Paper Only
Form and Instruction CMS-10137 EGWP PDP 2009 Application Instructions for PDP Sponsors to Offer New Employer/Union-Only Group Waiver Plans (EGWPs) 2009 EGWP PDP Application_Final.doc Yes Yes Paper Only
Other-redline redline 2009 Direct Contract MA-PD Application_OSORA vs FINAL.doc Yes Yes Paper Only
Other-redline redline 2009 Direct Contract PDP Application_OSORA vs FINAL.doc Yes Yes Paper Only
Other-redline redline 2009 EGWP Cost Application_OSORA vs Final.doc Yes Yes Paper Only
Other-redline redline 2009 EGWP PDP Application_OSORA vs Final.doc 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 CMS-10137 High level Summ_2009_Application_Revisions_092807.DOC 10/10/2007
CMS-10137 EPOG Part D Applications_High level summary of changes_Final CMS-10137 EPOG Part D Applications_High level summary of changes_Final.doc 10/10/2007
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.