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OMB Control No: 0938-0935	ICR Reference No: 201009-0938-017
Status: Historical Active	Previous ICR Reference No: 200910-0938-008
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Advantage Application - Part C and 1876 Cost Plan Expansion Application regulations under 42 CFR 422 subpart K & 417.400
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: 12/20/2010
	Date Received in OIRA: 09/30/2010
Terms of Clearance: Consistent with the PRA, this ICR should be re-submitted along with the publication of any draft "forthcoming guidance" documents to the extent that such guidance documents would result in new information collection, recordkeeping, or disclosure requirements or result in changes to burden or capital cost from existing requirements.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2011	36 Months From Approved	01/31/2011
Responses	870	0	291
Time Burden (Hours)	15,696	0	9,547
Cost Burden (Dollars)	0	0	0

Abstract: In order to provide health benefits to Medicare beneficiaries under the Medicare Advantage Program and/or the 1876 Cost Plan, applicant must meet regulatory requirements to enter into a contract with CMS, or to continue to contract with CMS. The revised Part C application is created to capture the applicants' information.

Authorizing Statute(s): PL: Pub.L. 108 - 173 1857 Name of Law: Medicare Advantage
   PL: Pub.L. 110 - 275 161 Name of Law: Provisions relating to Part C
   US Code: 42 USC 1395mm

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AP77	Final or interim final rulemaking	75 FR 19803	04/15/2010

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 33308	06/11/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 57035	09/17/2010
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
Part C Medicare Advantage Applications and 1876 Cost Plan Expansion Application (CY 2012)	CMS-10237

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	870	291	579
Annual Time Burden (Hours)	15,696	9,547	6,149
Annual Cost Burden (Dollars)	0	0	0

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

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to:

Short Statement: Increase in respondents: For contract year 2012, CMS expects a slight increase in initial applicants and SAE applications based on CY 2011 application submissions, and a major increase in the number SNP proposal submissions. Increase Burden of Hours: An additional 2 hours of burden was added to the base MA application. This increase stems from changes in regulations at 42 CFR 422 with regards to the compliance plans and quality improvement plans. CMS made an internal decision to have organizations' submit its compliance plan and quality improvement program plans as a part of the application process. CMS believes having this information will help us evaluation an organization understanding of the MA programs and the organization's readiness to serve beneficiaries as a MA contractor. CMS has also made an internal decision to have MA contractors that are currently offering a SNP product to complete and submit a modified SNP proposal. CMS believes having this information will help us better evaluate the quality of health care being offered across all SNP programs.

Annual Cost to Federal Government: $2,877,000

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Bonnie Harkless 4107865666

View ICR - OIRA Conclusion