OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EGWP

IC 43672 under ICR 200904-0938-006 · OMB 0938-0936.

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EGWP
 
No Modified
 
Mandatory
 
42 CFR 423.514 42 CFR 423.440 42 CFR 423.153 42 CFR 423.112 42 CFR 423.120 42 CFR 423.512

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction 2010 Part D MAPD_508.doc Yes Yes Paper Only
Instruction 2010 Part D PDP_508.doc Yes Yes Paper Only
Instruction 2010 Part D SAE application_508.doc Yes Yes Paper Only
Instruction 2010 Direct Contract MA-PD_508.doc Yes Yes Paper Only
Instruction 2010 Direct Contract PDP_508.doc Yes Yes Paper Only
Instruction 2010 EGWP Cost Application_508.doc Yes Yes Paper Only
Instruction 2010 EGWP PDP Application_508.doc Yes Yes Paper Only
Instruction 2010 PACE Part D_508.doc Yes Yes Paper Only
Instruction 2010 Part D Cost_508.DOC Yes Yes Paper Only

Health Health Care Services

 

455 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 455 0 0 0 0 455
Annual IC Time Burden (Hours) 11,890 0 0 0 0 11,890
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
2010 Chart for New EGWP Applicants _FINAL 2010 Chart for New EGWP Applicants _FINAL.doc 03/20/2009
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.