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

View Information Collection (IC)

Medicare Advantage Applications
 
No Modified
 
Voluntary
 
42 CFR 422.501

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10117 Yes Yes Fillable Printable
Form and Instruction CMS-10136 Yes Yes Fillable Printable
Form and Instruction CMS-10118 Yes Yes Fillable Printable
Form and Instruction CMS-10119 Yes Yes Fillable Printable
Form and Instruction CMS-10135 Yes Yes Fillable Printable


 

80 0
   
Private Sector Businesses or other for-profits
 
   50 %

  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 110 0 20 0 0 90
Annual IC Time Burden (Hours) 3,400 0 630 0 0 2,770
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Legal 1 08/22/2006
Essential 08/22/2006
Cert 08/22/2006
Guidelines 08/22/2006
legal 2 08/22/2006
Martrix 1 08/22/2006
Matrix 2 08/22/2006
Matrix 08/22/2006
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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