Solicitation for Applications for Medicare Prescription Drug Plan 2021 Contracts

Solicitation for Applications for Medicare Prescription Drug Plan 2021 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⚠️ Notice: This information collection may be referencing outdated material.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 2021 Contracts Form and Instruction
CMS-10137 Solicitation for Application for Medicare Prescription D 2021 Part D Application_PRA_v30day_CLEAN.pdf Form and Instruction
CMS-10137 PACE Medicare Part D Application 2020 PACE Part D Application PRA_v30day CLEAN.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Solicitation for Applications for Medicare Prescription Drug Plan 2021 Contracts	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 42 CFR 423.514 42 CFR 423.512 42 CFR 423.112 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 2021 Contracts	2021 Part D Application_PRA_v30day_CLEAN.pdf		Yes	Yes	Fillable Printable
Form and Instruction	CMS-10137	PACE Medicare Part D Application	2020 PACE Part D Application PRA_v30day CLEAN.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 290	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	290	34	256
Annual IC Time Burden (Hours)	1,385	-966	2,351
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.