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Medicare Advantage Applications - Part C
 
No Modified
 
Mandatory
 
42 CFR 422.524 42 CFR 422.527 42 CFR 422.502 42 CFR 422.505 42 CFR 422.514 42 CFR 422.520 42 CFR 422.501 42 CFR 422.503 42 CFR 422.504 42 CFR 422.506 42 CFR 422.508 42 CFR 422.510 42 CFR 422.512 42 CFR 422.516 42 CFR 422.500 42 CFR 422.521

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10237 Yes Yes Paper Only
Other-redline Yes Yes Paper Only
Form and Instruction CMS-10214 Yes Yes Paper Only
Other-redline Yes Yes Paper Only
Form and Instruction CMS-10214 Yes Yes Paper Only
Other-redline Yes Yes Paper Only
Other-5 Yes Yes Paper Only
Other-a Yes Yes Paper Only
Other-b Yes Yes Paper Only
Other-b Yes Yes Paper Only
Other-c Yes Yes Paper Only
Other-d Yes Yes Paper Only

Health Health Care Services

 

267 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 267 10 16 0 0 241
Annual IC Time Burden (Hours) 6,490 222 410 0 0 5,858
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS Admin-Management-Contract Matrix 09/08/2008
HFLC_CMS State Certification_082208 (comments) 09/08/2008
High level Summ_2010_Application_Revisions_090308 09/08/2008
LC-DraftAdminContract Matrix8-13-08clean (3) 09/08/2008
LC-DraftRevisedProvider Contract Matrix9208final (2) 09/08/2008
Revised HSD 1MARKUP 09/08/2008
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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