Applications for Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits (CMS-10237)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10237 Applications for Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits	Form and Instruction	Modified	Available
5_CMS Responses to 60_30 Day Comments_CY 2019.pdf	Supplementary Document	Uploaded 2018-01-29	Available
1_Summary of Changes (rev OSORA PRA).pdf	Supplementary Document	Uploaded 2018-01-29	Available
3_CMS-10237 - Supporting Statement A - Passback_CLEAN01252018.....docx	Supporting Statement A	Uploaded 2018-01-29	Available
8_CMS Responses to 60-Day Comments on the Contract Year 2019 PART C - Medi....pdf	Supplementary Document	Uploaded 2017-11-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
8785	Applications for Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits	Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0935	ICR Reference No: 201711-0938-005
Status: Historical Active	Previous ICR Reference No: 201610-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Applications for Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits (CMS-10237)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/02/2018
	Date Received in OIRA: 11/16/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	36 Months From Approved	02/29/2020
Responses	380	0	310
Time Burden (Hours)	6,246	0	10,941
Cost Burden (Dollars)	0	0	0

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Abstract: In order to provide health benefits to Medicare beneficiaries under the Medicare Advantage Program and/or the 1876 Cost Plan, applicant must meet regulatory requirements to enter into a contract with CMS, or to continue to contract with CMS.

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Authorizing Statute(s): US Code: 42 USC 1395mm Name of Law: null
   PL: Pub.L. 110 - 275 161 Name of Law: Provisions relating to Part C
   PL: Pub.L. 108 - 173 1857 Name of Law: Medicare Advantage
  

Citations for New Statutory Requirements: None

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EO 13771 Designation: Deregulatory

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 35782	08/01/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 53503	11/16/2017
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Applications for Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits	CMS-10237	Part C -Medicare Advantage and 1876 Cost Plan Expansion Application

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	380	310	0	0	70	0
Annual Time Burden (Hours)	6,246	10,941	0	0	-4,695	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There are significant reductions in the burden estimate for the CY 2019 application. These changes relate to: • Increased workload volume; • Changes in labor rates; • Reductions in application sections and attestations; • Reductions in application uploads; and • Removal of burden tied to other OMB control numbers. These burden reductions occur for both the industry and government burden estimates. Please refer to the supporting statement for additional information. Summary: The level of burden is projected to decrease from the CY 2018 application cycle to the CY 2019 application cycle.

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Annual Cost to Federal Government: $889,169

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/16/2017

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