CY 2013 Bid Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP)-CMS-10142

Bid Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0944 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10142 CY 2013 Bid Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP)-CMS-10142 Form
508_Compliant_CMS-10142_Attachment_E-1_CY2014_MA_BPT_Instructions.pdf Instruction
508_Compliant_CMS-10142_Attachment_E-2_CY2014_PD_BPT_Instructions.pdf Instruction
CMS-10142 MA-BPT 508_Compliant_CMS-10142_Attachment_D-1_CY2014_MA_BPT.pdf Form
CMS-10142 PD-BPT 508_Compliant_CMS-10142_Attachment_D-2_CY2014_PD_BPT.pdf Form
508_Compliant_CMS-10142_Attachment_C_BPT_changes.pdf Summary of BPT Changes IC Document

Information Collection (IC) Details

IC Title:	CY 2013 Bid Pricing Tool (BPT) for Medicare Advantage (MA) Plans and Prescription Drug Plans (PDP)-CMS-10142	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 422.252 42 CFR 422.250 42 CFR 422.254 42 CFR 422.256 42 CFR 422.258 42 CFR 422.262 42 CFR 422.264 42 CFR 422.266 42 CFR 422.270 42 CFR 422.300 42 CFR 422.304 42 CFR 422.306 42 CFR 422.308 42 CFR 422.310 42 CFR 422.312 42 CFR 422.314 42 CFR 422.316 42 CFR 422.318 42 CFR 422.320 42 CFR 422.322 42 CFR 422.324 42 CFR 423.251 42 CFR 423.258 42 CFR 423.350 42 CFR 423.265 42 CFR 423.272 42 CFR 423.279 42 CFR 423.286 42 CFR 423.293 42 CFR 423.301 42 CFR 423.308 42 CFR 423.315 42 CFR 423.322 42 CFR 423.329 42 CFR 423.336 42 CFR 423.343 42 CFR 423.346

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CMS-10142	MA-BPT	508_Compliant_CMS-10142_Attachment_D-1_CY2014_MA_BPT.pdf	Yes	Yes	Fillable Fileable
Form	CMS-10142	PD-BPT	508_Compliant_CMS-10142_Attachment_D-2_CY2014_PD_BPT.pdf	Yes	Yes	Fillable Fileable
Instruction			508_Compliant_CMS-10142_Attachment_E-1_CY2014_MA_BPT_Instructions.pdf	Yes	No	Fillable Fileable
Instruction			508_Compliant_CMS-10142_Attachment_E-2_CY2014_PD_BPT_Instructions.pdf	Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 555	Number of Respondents for Small Entity: 25

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,995	225	4,770
Annual IC Time Burden (Hours)	149,850	6,750	143,100
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Summary of BPT Changes	508_Compliant_CMS-10142_Attachment_C_BPT_changes.pdf	01/17/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.