Solicitation for Applications for Medicare Prescription Drug Plan 2020 Contracts

Solicitation for Applications for Medicare Prescription Drug Plan 2020 Contracts (CMS-10137)

⚠️ Notice: This information collection may be referencing outdated material.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 2020 Contracts Form and Instruction
CMS-10137 Solicitation for Application for Medicare Prescription D CMS-10137 2020 Part D Application.pdf Form and Instruction
CMS-10137 PACE Medicare Part D Application CMS-10137 2019 PACE Part D Application.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Solicitation for Applications for Medicare Prescription Drug Plan 2020 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 423.514 42 CFR 423.512 42 CFR 423.120 42 CFR 423.440 42 CFR 423.153

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	Solicitation for Application for Medicare Prescription Drug Plan 2020 Contracts	CMS-10137 2020 Part D Application.pdf		Yes	Yes	Fillable Printable
Form and Instruction	CMS-10137	PACE Medicare Part D Application	CMS-10137 2019 PACE Part D Application.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 256	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 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	256	13	243
Annual IC Time Burden (Hours)	2,351	111	2,240
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.