Information Collection

Medicare Advantage and Prescription Drug Benefit Program: Final Marketing Provisions referenced in 42 CFR 422.111(a)(3) and 423.128(a)(3)

IC 186438 under ICR 200910-0938-005 · OMB 0938-1051.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1051 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10260-MAOP Medicare Advantage and Prescription Drug Benefit Program: Final Marketing Provisions referenced in 42 CFR 422.111(a)(3) and 423.128(a)(3) Form and Instruction
CMS-10260-MAOP Annual Notice of Change & Evidence of Coverage for Medic Cover_and_EOC_Template_MA.pdf Form and Instruction
CMS-10260-CP Annual Notice of Change & Evidence of Coverage for Cost Cover_and_EOC_Template_Cost.pdf Form and Instruction
CMS-10260- MAPDP Annual Notice of Change & Evidence of Coverage for Medic Cover_and_EOC_Template_MAPDP.pdf Form and Instruction
CMS-10260-PDP's Annual Notice of Change & Evidence of Coverage for Presc Cover_and_EOC_Template_PDP.pdf Form and Instruction
CMS-10260- Annual Notice of Change & Evidence of Coverage for Provi cover_and_EOC_Template_PFFS.pdf Form and Instruction
CMS-10260-PPO Annual Notice of Change & Evidence of Coverage for Prefe Cover_and_EOC_Template_PPO.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medicare Advantage and Prescription Drug Benefit Program: Final Marketing Provisions referenced in 42 CFR 422.111(a)(3) and 423.128(a)(3)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 422.111(a)(3) 42 CFR 423.128(a)(3)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10260-MAOP	Annual Notice of Change & Evidence of Coverage for Medicare Advantage Only Plans	Cover_and_EOC_Template_MA.pdf	Yes	Yes	Paper Only
Form and Instruction	CMS-10260-CP	Annual Notice of Change & Evidence of Coverage for Cost Plans	Cover_and_EOC_Template_Cost.pdf	Yes	Yes	Paper Only
Form and Instruction	CMS-10260- MAPDP	Annual Notice of Change & Evidence of Coverage for Medicare Advantage Prescription Drug Plans	Cover_and_EOC_Template_MAPDP.pdf	Yes	Yes	Paper Only
Form and Instruction	CMS-10260-PDP's	Annual Notice of Change & Evidence of Coverage for Prescription Drug Plans	Cover_and_EOC_Template_PDP.pdf	Yes	Yes	Paper Only
Form and Instruction	CMS-10260-	Annual Notice of Change & Evidence of Coverage for Provider Fee‐for‐Service Plans	cover_and_EOC_Template_PFFS.pdf	Yes	Yes	Paper Only
Form and Instruction	CMS-10260-PPO	Annual Notice of Change & Evidence of Coverage for Preferred Provider Organizations	Cover_and_EOC_Template_PPO.pdf	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 740	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	740	70	670
Annual IC Time Burden (Hours)	8,880	840	8,040
Annual IC Cost Burden (Dollars)	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.