The Plan Benefit Package (PBP) and Formulary Submission for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDPs)

ICR 200502-0938-011

OMB: 0938-0763

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0763 200502-0938-011
Historical Active 200303-0938-005
HHS/CMS
The Plan Benefit Package (PBP) and Formulary Submission for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDPs)
Revision of a currently approved collection   No
Emergency 03/18/2005
Approved with change 04/11/2005
Retrieve Notice of Action (NOA) 02/25/2005
  Inventory as of this Action Requested Previously Approved
08/31/2005 08/31/2005 07/31/2006
2,092 0 200
5,546 0 600
0 0 0

Under the Medicare Modernization Act, Medicare Advantage and Prescription Drug Plan organizations are requied to submit plan benefit package information to CMS for approval. Organizations will provide this information through the submission of the formulary and the Plan Benefit Package software.

None
None


No

1
IC Title Form No. Form Name
The Plan Benefit Package (PBP) and Formulary Submission for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDPs) CMS-R-262

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,092 200 0 1,892 0 0
Annual Time Burden (Hours) 5,546 600 0 4,946 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/25/2005


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