Information Collection Request

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

ICR 201211-0938-006 · OMB 0938-0936 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form CMS-10137 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
UHC_Comments_for_MAPD_Application(1) (CMS-10137).xlsx Supplementary Document Uploaded 2012-12-19 Available
Attachment 2 2014 Application Comment tracker 30 day.xlsx Supplementary Document Uploaded 2012-11-21 Available
508_Summ_2014_Part_D_Application_Revisions 30 day.pdf Supplementary Document Uploaded 2012-11-21 Available
0938-0936.Revised Supporting Statement Part A (12-18-12).docx Supporting Statement A Uploaded 2012-12-19 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
12/31/2015 36 Months From Approved 02/28/2013
241 0 178
2,132 0 2,322
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, CMS-10137 Part D Application ,   2013 PACE Application

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 241 178 0 0 63 0
Annual Time Burden (Hours) 2,132 2,322 0 -221 31 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No