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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Appendix B - CY 2010 PBP and Formulary Changes.pdf	Supplementary Document	Uploaded 2009-01-16	Available
CY 2010 RESPONSE_CMS-R-262 60 Day Comments_12192008.pdf	Supplementary Document	Uploaded 2009-01-16	Available
Appendix A - CY2010 PBP Sprtng Stmnt - 12162008.pdf	Supporting Statement A	Uploaded 2009-01-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43667	CY2010 Plan Benefit Package (PBP) Software and Formulary Submission - CMS-R-262	Other-file layout	Modified

ICR Details

OMB Control No: 0938-0763	ICR Reference No: 200901-0938-005
Status: Historical Active	Previous ICR Reference No: 200801-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs)
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: 03/30/2009
	Date Received in OIRA: 01/23/2009
Terms of Clearance: As this ICR is associated with the 45 day advance notice and call letter, which are both issued annually, this ICR is approved for 18 months. This ICR is approved on the understanding that, going forward, this ICR is related to the 45 day advance notice and call letter and that, as such, CMS agrees to sync up the public comment period for this ICR with the public comment period for the 45 day advance notice and the call letter. Even if CMS believes that the policies contained in the 45 day advance notice and call letter do not impact burden, the public shall be provided an opportunity to comment on CMS's burden assessment. To facilitate meaningful public comment, CMS agrees to reference this ICR by OMB control number in the 45 day advance notice and call letter, as appropriate. To the extent that changes in the 45 day advance notice and the call letter impact burden, the burden estimates in this ICR should be revised accordingly. Previous terms of clearance remain in effect.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2010	36 Months From Approved	03/31/2011
Responses	4,988	0	4,988
Time Burden (Hours)	12,113	0	11,400
Cost Burden (Dollars)	0	0	0

---

Abstract: CMS requires that MA and PDP organizations submit a completed formulary and PBP as part of the annual bidding process. During this process, organizations prepare their proposed plan benefit packages for the upcoming contract year and submit them to CMS for review and approval.

---

Authorizing Statute(s): PL: Pub.L. 108 - 173 101 Name of Law: Prescription Drug, Improvement, and Modernization Act of2003 (MMA)
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
0938-AN08	Final or interim final rulemaking	70 FR 4193	10/01/2005

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 60296	10/10/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 902	01/09/2009
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
CY2010 Plan Benefit Package (PBP) Software and Formulary Submission - CMS-R-262

---

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	4,988	4,988	0	0	0	0
Annual Time Burden (Hours)	12,113	11,400	0	0	713	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: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $835,244

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)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(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: 01/23/2009

---