Information Collection

Solicitation for Applications for Medicare Prescription Drug Plan 2017 Contracts

IC 43672 under ICR 201509-0938-014 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Solicitation for Applications for Medicare Prescription Drug Plan 2017 Contracts	Form and Instruction
CMS-10137 Medicare Part D Application for New PACE Organizations 2 2016 PACE Part D Application 30 Day PRA.pdf	Form and Instruction
CMS-10137 Solicitation for Applications for Medicare Prescription 2017 Part D Application_30day_PRA.pdf	Form and Instruction
Part_D_Summ_2017_Application_Revisions_technical__substantive_v30_day.docx Crosswalk	IC Document

IC Title:

Solicitation for Applications for Medicare Prescription Drug Plan 2017 Contracts

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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

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	Medicare Part D Application for New PACE Organizations 2016 Contract Year	2016 PACE Part D Application 30 Day PRA.pdf		Yes	Yes	Fillable Printable
Form and Instruction	CMS-10137	Solicitation for Applications for Medicare Prescription Drug Plan 2017 Contracts	2017 Part D Application_30day_PRA.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 230

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 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	230	-9	239
Annual IC Time Burden (Hours)	2,109	-84	2,193
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Crosswalk	Part_D_Summ_2017_Application_Revisions_technical__substantive_v30_day.docx	09/30/2015

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