Information Collection

Solicitation for Applications for Medicare Prescription Drug Plan 2018 Contracts

IC 43672 under ICR 201610-0938-010 · 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⚠️ Notice: This information collection may be referencing outdated material.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 2018 Contracts Form and Instruction
CMS-10137 Medicare Part D Application for New PACE Organizations 2 2017 PACE Part D Application PRA_v30day [rev 10-04-2016 by OSORA PRA].pdf Form and Instruction
CMS-10137 Solicitation for Applications for Medicare Prescription 2018 Part D Application_PRA_v30day CLEAN [rev 11-04-2016 by OSORA PRA].pdf Form and Instruction
Part_D_Summ_2018_Application_Revisions_technical__substantive_v60_day.docx Crosswalk - Application IC Document
2018 Part D Application_PRA_v60day REDLINE.docx Redline/Strikeout - Application IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Solicitation for Applications for Medicare Prescription Drug Plan 2018 Contracts	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 423.153 42 CFR 423.514 42 CFR 423.112 42 CFR 423.440 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 2017 Contract Year	2017 PACE Part D Application PRA_v30day [rev 10-04-2016 by OSORA PRA].pdf		Yes	Yes	Fillable Printable
Form and Instruction	CMS-10137	Solicitation for Applications for Medicare Prescription Drug Plan 2018 Contracts	2018 Part D Application_PRA_v30day CLEAN [rev 11-04-2016 by OSORA 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: 160	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	160	-70	230
Annual IC Time Burden (Hours)	1,565	-544	2,109
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Crosswalk - Application	Part_D_Summ_2018_Application_Revisions_technical__substantive_v60_day.docx	11/04/2016
Redline/Strikeout - Application	2018 Part D Application_PRA_v60day REDLINE.docx	11/04/2016

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