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 CMS-10214 Yes Yes Paper Only
Instruction Yes Yes Paper Only
Form and Instruction CMS-10117 Yes Yes Paper Only
Form and Instruction CMS-10136 Yes Yes Paper Only
Form and Instruction CMS-10118 Yes Yes Paper Only
Form and Instruction CMS-10119 Yes Yes Paper Only
Form and Instruction CMS-10135 Yes Yes Paper Only

Health Health Care Services

 

220 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 220 0 0 0 0 220
Annual IC Time Burden (Hours) 5,580 0 0 0 0 5,580
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
MEDICARE ADVANTAGE GUIDELINES 06/15/2007
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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