Information Collection Request

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

ICR 201009-0938-008 · OMB 0938-0936 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10137 Cost CY 2012-Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EGWP Form and Instruction Modified Available
Summ_2012_Application_Revisions_technical and substantive.pdf Supplementary Document Uploaded 2010-09-17 Available
2012 Part D 60 Day Comments Final CMS-10137.xls Supplementary Document Uploaded 2010-09-17 Available
2012 PDP formatted_rl30day.doc Supplementary Document Uploaded 2010-09-17 Available
2012 PACE Part D_rl30day.doc Supplementary Document Uploaded 2010-09-17 Available
2012 MA-PD formatted_rl30day.doc Supplementary Document Uploaded 2010-09-17 Available
2012 Cost formatted_rl30day.doc Supplementary Document Uploaded 2010-09-17 Available
supporting_statement 9_16_2010.pdf Supporting Statement A Uploaded 2010-09-17 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
43672 CY 2012-Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EGWP Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
12/31/2011 36 Months From Approved 01/31/2011
295 0 453
3,576 0 11,919
0 0 0





Reginfo record details
1
table that charts list of burden
IC Title Form No. Form Name
CY 2012-Applications for Medicare Part D Plans; PDP Plans, MA-PD Plans, Cost Plans, PACE Organizations, SAE and EGWP CMS-10137 Cost, CMS-10137 PACE, CMS-10137 PDP, CMS-10137 SAE, CMS-10137 MA-PD Application for New Cost Plan ,   Application for New PACE Organization ,   Application for New PDP ,   SAE Application for PDP and MA-PD ,   Application for New MA-PD

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 295 453 0 -158 0 0
Annual Time Burden (Hours) 3,576 11,919 0 -8,343 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No