View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

CY 2012-Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EGWP
 
No Modified
 
Mandatory
 
42 CFR 423.514 42 CFR 423.440 42 CFR 423.153 42 CFR 423.112 42 CFR 423.120 42 CFR 423.512

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10137 Cost Application for New Cost Plan 2012 Cost formatted_clean30day.pdf Yes Yes Paper Only
Form and Instruction CMS-10137 PACE Application for New PACE Organization 2012 PACE Part D_clean30day.pdf Yes Yes Paper Only
Form and Instruction CMS-10137 PDP Application for New PDP 2012 PDP formatted_clean30day.pdf Yes Yes Paper Only
Form and Instruction CMS-10137 SAE SAE Application for PDP and MA-PD 2012 SAE formatted_clean30day.pdf Yes Yes Paper Only
Form and Instruction CMS-10137 MA-PD Application for New MA-PD 2012 MA-PD formatted_clean30day.pdf Yes Yes Paper Only

Health Health Care Services

 

295 0
   
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 295 0 -158 0 0 453
Annual IC Time Burden (Hours) 3,576 0 -8,343 0 0 11,919
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
2012 Cost formatted_rl30day 2012 Cost formatted_rl30day.doc 09/17/2010
2012 MA-PD formatted_rl30day 2012 MA-PD formatted_rl30day.doc 09/17/2010
2012 PACE Part D_rl30day 2012 PACE Part D_rl30day.doc 09/17/2010
2012 PDP formatted_rl30day 2012 PDP formatted_rl30day.doc 09/17/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.