Part C Medicare Advantage Application and 1876 Cost Plan Expansion Application

Medicare Advantage Application - Part C and 1876 Cost Plan Expansion Application Regulations under 42 CFR 422 (Subpart K) & 417.400 (CMS-10237)

Step 1 - Disclosure Statement (30day) Final

Part C Medicare Advantage Application and 1876 Cost Plan Expansion Application

OMB: 0938-0935

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PRA Disclosure Statement


PUBLIC REPORTING BURDEN: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0935. The time required to complete this information collection is estimated to average 50 hours per response, including the time to review instructions, search existing data resources, and gather the data needed, and complete and review the information collection. If you have any comments, concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to CMS, Attn: Reports Clearance Officer, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.
























File Typeapplication/msword
File TitleAccording to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
AuthorHCFA Software Control
Last Modified ByWANDA PIGATT-CANTY
File Modified2015-09-18
File Created2015-09-18

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