Information Collection

Solicitation for Applications for Medicare Prescription Drug Plan 2016 Contracts

IC 43672 under ICR 201409-0938-015 · OMB 0938-0936.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0936 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10137 Solicitation for Applications for Medicare Prescription Drug Plan 2016 Contracts Form and Instruction
CMS-10137 Medicare Part D Application for New PACE Organizations ( 2015 Application for New PACE_30day PRA.pdf Form and Instruction
CMS-10137 Solicitation for Applications for Medicare Prescription 2016 Part D Application_30dayPRA.pdf Form and Instruction
Part_D_Summ_2016_Application_Revisions_technical__substantive_v30_day.docx Crosswalk IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Solicitation for Applications for Medicare Prescription Drug Plan 2016 Contracts	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 423.514 42 CFR 423.440 42 CFR 423.153 42 CFR 423.112 42 CFR 423.512 42 CFR 423.120

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10137	Medicare Part D Application for New PACE Organizations (2015 Contract Year)	2015 Application for New PACE_30day PRA.pdf		Yes	Yes	Fillable Printable
Form and Instruction	CMS-10137	Solicitation for Applications for Medicare Prescription Drug Plan 2016 Contracts	2016 Part D Application_30dayPRA.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 239	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	239	-15	254
Annual IC Time Burden (Hours)	2,193	-126	2,319
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk	Part_D_Summ_2016_Application_Revisions_technical__substantive_v30_day.docx	09/26/2014

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