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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10137 EGWP PDP 2009 Application Instructions for PDP Sponsors to Offer New Employer/Union-Only Group Waiver Plans (EGWPs)	Form and Instruction	Modified	Available
Form CMS-10137 EGWP COS 2009 Application Instructions for Cost Plan Sponsors to Offer New Employer/Union-Only Group Waiver Plans (EGWPs)	Form and Instruction	Modified	Repair queued
Form CMS-10137 Employer 2009 Solicitation for Applications for New Employer/Union Direct Contract Prescription Drug Plan (PDP) Sponsors	Form and Instruction	Modified	Available
Form CMS-10137 Employer 2009 Solicitation for Applications for New Employer/Union Direct Contract Medicare Advantage Prescription Drug Plan (MA-PD) Sponcors	Form and Instruction	Modified	Available
Form CMS-10137 SAE 2009 PART D SERVICE AREA EXPANSION APPLICATION for PRESCRIPTION DRUG PLAN (PDP) SPONSORS and MEDICARE ADVANTAGE PRESCRIPTION DRUG PLAN MEDICARE ADVANTAGE PRESCRIPTION DRUG PLAN contract year 2009	Form and Instruction	Modified	Available
Form CMS-10137 PDP Solicitation for Applications for New Prescription Drug Plans (PDP) Sponsors 2009 Contract Year	Form and Instruction	Modified	Available
Form CMS-10137 MAPD Solicitation for Applications for New Medicare Advantage Prescription Drug Plan (MA-PD) Sponsors 2009 Contract Year	Form and Instruction	Modified	Available
Form CMS-10137 COST Solicitation for Applications for New Cost Plan Sponsors Contract Year 2009	Form and Instruction	Modified	Available
Form CMS-10137 PACE Medicare Part D Application for New PACE Organizations 2009 Contract Year	Form and Instruction	Modified	Available
Part D Final comments chart.xls	Supplementary Document	Uploaded 2007-12-06	Available
Final Summ_2009_Part D Application_Revisions.DOC	Supplementary Document	Uploaded 2007-12-06	Available
CMS-10137 30-day comment #1.pdf	Supplementary Document	Uploaded 2007-12-06	Available
CMS-10137 30-day comments #2 thru #4.pdf	Supplementary Document	Uploaded 2007-12-06	Available
CY2009comments.xls	Supplementary Document	Uploaded 2007-10-10	Available
CMS-10137 EPOG Part D Applications_High level summary of changes_Final.doc	Supplementary Document	Uploaded 2007-10-10	Available
CMS-10137 High level Summ_2009_Application_Revisions_092807.DOC	Supplementary Document	Uploaded 2007-10-10	Available
CMS-10137 30 day revised supporting_statement092807.doc	Supporting Statement A	Uploaded 2007-10-10	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 EGWP	Form and Instruction	Modified	2009 Application Instructions for PDP Sponsors to Offer New Employer/Union-Only Group Waiver Plans (EGWPs)
43672	Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EGWP	Form and Instruction	Modified	2009 Application Instructions for Cost Plan Sponsors to Offer New Employer/Union-Only Group Waiver Plans (EGWPs)
43672	Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EGWP	Form and Instruction	Modified	2009 Solicitation for Applications for New Employer/Union Direct Contract Prescription Drug Plan (PDP) Sponsors
43672	Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EGWP	Form and Instruction	Modified	2009 Solicitation for Applications for New Employer/Union Direct Contract Medicare Advantage Prescription Drug Plan (MA-PD) Sponcors
43672	Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EGWP	Form and Instruction	Modified	2009 PART D SERVICE AREA EXPANSION APPLICATION for PRESCRIPTION DRUG PLAN (PDP) SPONSORS and MEDICARE ADVANTAGE PRESCRIPTION DRUG PLAN MEDICARE ADVANTAGE PRESCRIPTION DRUG PLAN contract year 2009
43672	Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EGWP	Form and Instruction	Modified	Solicitation for Applications for New Prescription Drug Plans (PDP) Sponsors 2009 Contract Year
43672	Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EGWP	Form and Instruction	Modified	Solicitation for Applications for New Medicare Advantage Prescription Drug Plan (MA-PD) Sponsors 2009 Contract Year
43672	Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EGWP	Form and Instruction	Modified	Solicitation for Applications for New Cost Plan Sponsors Contract Year 2009
43672	Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EGWP	Form and Instruction	Modified	Medicare Part D Application for New PACE Organizations 2009 Contract Year
43672	Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EGWP	Other-redline	Modified

ICR Details

OMB Control No: 0938-0936	ICR Reference No: 200710-0938-005
Status: Historical Active	Previous ICR Reference No: 200707-0938-001
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 EGWP
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/07/2008
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/17/2007
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	01/31/2011	36 Months From Approved	09/30/2010
Responses	455	0	857
Time Burden (Hours)	11,890	0	28,122
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 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

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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 EGWP	CMS-10137 PACE, CMS-10137 COST, CMS-10137 MAPD, CMS-10137 PDP, CMS-10137 SAE, CMS-10137 Employer Union MAPD, CMS-10137 Employer Union PDP, CMS-10137 EGWP COST, CMS-10137 EGWP PDP	Medicare Part D Application for New PACE Organizations 2009 Contract Year ,   Solicitation for Applications for New Cost Plan Sponsors Contract Year 2009 ,   Solicitation for Applications for New Medicare Advantage Prescription Drug Plan (MA-PD) Sponsors 2009 Contract Year ,   Solicitation for Applications for New Prescription Drug Plans (PDP) Sponsors 2009 Contract Year ,   2009 PART D SERVICE AREA EXPANSION APPLICATION for PRESCRIPTION DRUG PLAN (PDP) SPONSORS and MEDICARE ADVANTAGE PRESCRIPTION DRUG PLAN MEDICARE ADVANTAGE PRESCRIPTION DRUG PLAN contract year 2009 ,   2009 Solicitation for Applications for New Employer/Union Direct Contract Medicare Advantage Prescription Drug Plan (MA-PD) Sponcors ,   2009 Solicitation for Applications for New Employer/Union Direct Contract Prescription Drug Plan (PDP) Sponsors ,   2009 Application Instructions for Cost Plan Sponsors to Offer New Employer/Union-Only Group Waiver Plans (EGWPs) ,   2009 Application Instructions for PDP Sponsors to Offer New Employer/Union-Only Group Waiver Plans (EGWPs)

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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	455	857	0	-402	0	0
Annual Time Burden (Hours)	11,890	28,122	0	-16,232	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to: Using Information Technology

Short Statement: Several attestations were added or clarified based on the 2008 Call Letter that was issued by CMS and the guidance contained in the Medicare Prescription Drug Benefit Manual. In addition, the remainder of the Part D applications is being automated through CMS' Health Plan Management System (HPMS), which will reduce the hour burden for each applicant (see Supporting Statement for more detail).

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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: 10/17/2007

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