Information Collection

Solicitation for Applications for Medicare Prescription Drug Plan 2019 Contracts

IC 43672 under ICR 201711-0938-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 2019 Contracts	Form and Instruction
CMS-10137 Medicare Part D Application for New PACE Organizations ( 2018 PACE Part D Application PRA_v30day CLEAN CMS 10137 OMB 938 936 (rev 001 by OSORA PRA).pdf	Form and Instruction
CMS-10137 Solicitation for Applications for Medicare Prescription 2019 Part D Application_PRA_v30dayCLEAN CMS 10137 OMB 938936 (rev 001 by OSORA PRA).pdf	Form and Instruction

IC Title:

Solicitation for Applications for Medicare Prescription Drug Plan 2019 Contracts

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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

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 (2018 Contract Year)	2018 PACE Part D Application PRA_v30day CLEAN CMS 10137 OMB 938 936 (rev 001 by OSORA PRA).pdf		Yes	Yes	Fillable Printable
Form and Instruction	CMS-10137	Solicitation for Applications for Medicare Prescription Drug Plan 2019 Contracts	2019 Part D Application_PRA_v30dayCLEAN CMS 10137 OMB 938936 (rev 001 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: 540

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	243	83	160
Annual IC Time Burden (Hours)	2,240	675	1,565
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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