View Information Collection Request (ICR) Package

OMB Control No: 0938-0935	ICR Reference No: 200801-0938-004
Status: Historical Active	Previous ICR Reference No: 200707-0938-002
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Advantage Applications - Part C
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/14/2008
	Date Received in OIRA: 01/11/2008
Terms of Clearance: Terms of Clearance: This collection is approved under the following terms of clearance: Upon publishing a new 60-day and 30-day Federal Register Notice, CMS will provide the public and OMB with a supplemental document that crosswalks all changes (technical and substantive) made to the revised ICR. The document should include an explanation of each change from the previous approval, the reason why the change is necessary and the citation or reference to the statute, regulation or guidance document that support the need for the change. The crosswalk should also address an increase or decrease in burden for each change.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2011	36 Months From Approved	01/31/2011
Responses	241	0	220
Time Burden (Hours)	5,858	0	5,580
Cost Burden (Dollars)	0	0	0

Abstract: Health plans must meet regulatory requirements to enter into a contract with CMS; in order to provide health benefits to Medicare beneficiaries. The revised MA applications are the collection receptacles required.

Authorizing Statute(s): PL: Pub.L. 108 - 173 1857 Name of Law: Medicare Advantage
PL: Pub.L. 108 - 173 1857 Name of Law: Contracts with Medicare+Choice Organizations

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 38601	07/13/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 58096	10/12/2007
Did the Agency receive public comments on this ICR? Yes

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Medicare Advantage Applications - Part C	CMS-10214, CMS-10237, CMS-10214	, ,

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	241	220	21
Annual Time Burden (Hours)	5,858	5,580	278
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: It is expected that multiple applications from individual respondents will result in minimal additional cost to the government. CMS encouraged plans to submit a Notices of Intent (NOI). The NOIs allows organizations to provide CMS an early estimate of the applications they intend to submit. NOIs will be received and entered into our Health Plan Management System (HPMS). As a result, the total burden will be increased slightly to provide a more accurate depiction of the number of applications CMS expects to receive. Finally, for 2009 contracts awarded in September 2009; will renew annually; unless otherwise notified by CMS. Organizations holding 2008 contracts will not need to re-apply in 2009 and may continue providing services to beneficiaries unless otherwise notified by CMS.

Annual Cost to Federal Government: $270,187

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Bonnie Harkless 4107865666

View ICR - OIRA Conclusion