Information Collection Request

Applications for Medicare Part D plans: PDP Plans, MA-PD Plans, Cost Plans, PACE organizations, SAE and EPOG

ICR 200611-0938-011 · OMB 0938-0936 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10137 Application for New Cost Plan Form and Instruction Modified Available
Form CMS-10137 Application for New MA-PD Form and Instruction Modified Available
Form CMS-10137 Application for New PDP Form and Instruction Modified Available
Form CMS-10137 SAE Application Form and Instruction Modified Available
Form CMS-10137 EPOG Application for Existing PDP Form and Instruction Modified Available
Form CMS-10137 EPOG Application for New EPOG PDP Form and Instruction Modified Available
Form CMS-10137 Application for New MA-PD Form and Instruction Modified Available
Form CMS-10137 Application for New Employer Form and Instruction Modified Available
Form CMS-10137 EPOG Application for EPOG Form and Instruction Modified Available
Form CMS-10137 Application for New Cost Plan Form and Instruction Modified Available
Form CMS-10137 SAE Application Form and Instruction Modified Available
Form CMS-10137 Application for New PDP Form and Instruction Modified Available
Form CMS-10137 EPOG Application for EPOG Cost Plans Form and Instruction Modified Available
Section 3.4 Pharmacy Access.htm Supplementary Document Uploaded 2007-01-05 Available
RE Draft 2008 Prescription Drug Plan Solicitations for Public Comment.htm Supplementary Document Uploaded 2007-01-05 Available
Question about Territories.htm Supplementary Document Uploaded 2007-01-05 Available
PART D application comments.htm Supplementary Document Uploaded 2007-01-05 Available
MA PD application comments.htm Supplementary Document Uploaded 2007-01-05 Available
Draft 2008 Part D Applications Comments UHG FINAL 11 20 06doc.pdf Supplementary Document Uploaded 2007-01-05 Available
Applications2008_09da_FinalAHIPComments_Ltrhd_11-20-06.doc Supplementary Document Uploaded 2007-01-05 Available
2008Applic Coms 11-20.doc Supplementary Document Uploaded 2007-01-05 Available
CY2008APPcomments120706.xls Supplementary Document Uploaded 2007-01-05 Available
Summ_2008_EPOG_Applications_HighLevelRevisions_110806.DOC Supplementary Document Uploaded 2006-11-15 Available
Justification_for_Emergency_PRA_Clearance110306.doc Supplementary Document Uploaded 2006-11-09 Available
CMS-10137 Summ_2008_Application_HighLevelRevisions_110706.DOC Supplementary Document Uploaded 2006-11-09 Available
CMS-10137 supporting_statement110306.doc Supporting Statement A Uploaded 2006-11-09 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
43672 Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG Form and Instruction ModifiedApplication for New Cost Plan
43672 Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG Form and Instruction ModifiedApplication for New MA-PD
43672 Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG Form and Instruction ModifiedApplication for New PDP
43672 Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG Form and Instruction ModifiedSAE Application
43672 Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG Form and Instruction ModifiedApplication for Existing PDP
43672 Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG Form and Instruction ModifiedApplication for New EPOG PDP
43672 Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG Form and Instruction ModifiedApplication for New MA-PD
43672 Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG Form and Instruction ModifiedApplication for New Employer
43672 Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG Form and Instruction ModifiedApplication for EPOG
43672 Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG Form and Instruction ModifiedApplication for New Cost Plan
43672 Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG Form and Instruction ModifiedSAE Application
43672 Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG Form and Instruction ModifiedApplication for New PDP
43672 Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG Form and Instruction ModifiedApplication for EPOG Cost Plans

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2007 6 Months From Approved 11/30/2009
216 0 101
5,316 0 3,828
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG CMS-10137, CMS-10137, CMS-10137, CMS-10137 EPOG, CMS-10137, CMS-10137, CMS-10137 EPOG, CMS-10137 EPOG, CMS-10137 EPOG, CMS-10137, CMS-10137, CMS-10137, CMS-10137 ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,   ,  

table that charts list of burden
  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 216 101 115 0 0 0
Annual Time Burden (Hours) 5,316 3,828 1,488 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No