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

View Information Collection (IC)

Part C Medicare Advantage Applications and 1876 Cost Plan Expansion Application (CY 2012)
 
No Modified
 
Mandatory
 
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 422.502 42 CFR 422.505 42 CFR 422.514 42 CFR 422.520 42 CFR 422.521 42 CFR 422.524 42 CFR 417.400 42 CFR 422.527

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10237 Yes Yes Printable Only

Health Health Care Services

 

870 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 870 0 579 0 0 291
Annual IC Time Burden (Hours) 15,696 0 6,149 0 0 9,547
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CMS MA Additional and Supplment Benefits Table (2012 Draft) 09/17/2010
CMS MA Contract and Signature Index-Facilities (2012 Draft) 09/17/2010
2012 Draft HSD Instructions Clean (PRA-30daynotice) 09/17/2010
CMS MA Facility Table (2012 Draft) 09/17/2010
CMS MA Provider Table (2012 Draft) 09/17/2010
CMS MA Signature Authority Grid (2012 Draft) 09/17/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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