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Medicare Advantage Applications - Part C (CY 2010)
Medicare Advantage Applications - Part C and regulations under 42 CFR 422 subpart K
OMB: 0938-0935
IC ID: 8785
OMB.report
HHS/CMS
OMB 0938-0935
ICR 200906-0938-003
IC 8785
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0935 can be found here:
2024-11-19 - Revision of a currently approved collection
2022-10-13 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form CMS-10237
Medicare Advantage Applications - Part C (CY 2010)
Form and Instruction
CMS-10237 Part-C Medicare Advantage Application
CMS10237-PartC-MA-APP-CLEANVERSION-12-4-08.doc
Form and Instruction
CMS-10214 Medicare Advantage/Prescription Drug Benefit
CMS-10214 2009 EGWP MAO Applicationfinal1125(cleanversion).doc
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Medicare Advantage Applications - Part C (CY 2010)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
42 CFR 422.501
42 CFR 422.503
42 CFR 422.504
42 CFR 422.506
42 CFR 422.508
42 CFR 422.510
42 CFR 422.512
42 CFR 422.516
42 CFR 422.500
42 CFR 422.502
42 CFR 422.505
42 CFR 422.514
42 CFR 422.520
42 CFR 422.521
42 CFR 422.524
42 CFR 422.527
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
CMS-10237
Part-C Medicare Advantage Application
CMS10237-PartC-MA-APP-CLEANVERSION-12-4-08.doc
Yes
Yes
Paper Only
Form and Instruction
CMS-10214
Medicare Advantage/Prescription Drug Benefit
CMS-10214 2009 EGWP MAO Applicationfinal1125(cleanversion).doc
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
267
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
100 %
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
267
0
0
0
0
267
Annual IC Time Burden (Hours)
6,490
0
0
0
0
6,490
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.