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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10137 Medicare Part D Application for New PACE Organizations (2015 Contract Year) Solicitation for Applications for Medicare Prescription Drug Plan 2016 Contracts	Form and Instruction
Form CMS-10137 Solicitation for Applications for Medicare Prescription Drug Plan 2016 Contracts 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

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10137				Yes	Yes	Fillable Printable
Form and Instruction	CMS-10137				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: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk		09/26/2014

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

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