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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS--10137 EPOG Direct MAPD Plans	Form	Modified	Available
Form CMS-10137 SAE Applications	Form and Instruction	Modified	Available
Form CMS-10137 MA Plans	Form and Instruction	Modified	Available
Form CMS-10137 EPOG Direct Contract Plans	Form and Instruction	Modified	Available
Form CMS-10137 App New Cost Plans	Form and Instruction	Modified	Available
Form CMS-10137 Application New Dug Plans	Form and Instruction	Modified	Available
Final 2008 summaryApplication_HighLevelRevisions.doc	Supplementary Document	Uploaded 2007-09-11	Available
CMS-10137 supporting_statement021507.doc	Supporting Statement A	Uploaded 2007-06-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43672	Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG	Form	Modified	EPOG Direct MAPD Plans
43672	Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG	Form and Instruction	Modified	SAE Applications
43672	Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG	Form and Instruction	Modified	MA Plans
43672	Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG	Form and Instruction	Modified	EPOG Direct Contract Plans
43672	Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG	Form and Instruction	Modified	App New Cost Plans
43672	Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG	Form and Instruction	Modified	Application New Dug Plans
43672	Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EPOG	Instruction	Modified

ICR Details

OMB Control No: 0938-0936	ICR Reference No: 200707-0938-001
Status: Historical Active	Previous ICR Reference No: 200611-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Applications for Medicare Part D plans: PDP Plans, MA-PD Plans, Cost Plans, PACE organizations, SAE and EPOG
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: 09/12/2007
Retrieve Notice of Action (NOA)	Date Received in OIRA: 07/13/2007
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. .

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2010	36 Months From Approved	09/30/2007
Responses	857	0	216
Time Burden (Hours)	28,122	0	5,316
Cost Burden (Dollars)	0	0	0

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Abstract: The Applications for Part D sponsors to offer qualified prescription drug coverage are completed by entities seeking approval to offer Part D benefits under the Medicare Prescription Drug Benefit program established by section 101 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and is codified in section 1860D of the Social Security Act (the Act).

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Authorizing Statute(s): PL: Pub.L. 108 - 173 1860D Name of Law: Medicare Prescription Drug Benefit Program
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 13793	03/23/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 31840	06/08/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 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, CMS-10137, CMS--10137	Application New Dug Plans ,   App New Cost Plans ,   EPOG Direct Contract Plans ,   MA Plans ,   SAE Applications ,   EPOG Direct MAPD Plans

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ICR Summary of Burden

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	857	216	0	641	0	0
Annual Time Burden (Hours)	28,122	5,316	0	22,806	0	0
Annual Cost Burden (Dollars)	0	0	0	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: Several attestations were removed from the Part D Applications after emergency approval was granted. These attestations were removed based on subsequent OMB concern raised during the review of the Part C applications. As a result, the burden hours to complete an application were even further reduced then previously calculated. Subsequent to the emergency approval of the Part D applications, CMS received Notices of Intent to apply for the 2008 contract year that far exceeded original expectations. The increase in the number of applicants is the reason that the annual hour burden actually increased from what was approved for emergency clearance (see Supporting Statement for more detail). Number of Applicants increased due to MMA statute allowing Local PPOs into the marketplace for the first time in 2008 and a larger than expected volume of applicants seeking to offer Private Fee For Service plans with Part D.

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Annual Cost to Federal Government: $100,800

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

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 07/13/2007

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