Election Process (MA organization)

Model Medicare Advantage and Medicare Prescription Drug Plan Individual Enrollment Request Form (CMS-10718)

OMB: 0938-1378

IC ID: 240722

Information Collection (IC) Details

View Information Collection (IC)

Election Process (MA organization)
 
No New
 
Required to Obtain or Retain Benefits
 
42 CFR 422.50 42 CFR 422.60

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10718 Enrollment Form 'NEW' CY 2021 MODEL MA PDP Indiv Enrollment Request Form_Final.pdf Yes Yes Fillable Printable

Health Health Care Services

Medicare Advantage Prescription Drug (MARx) System  83 FR 6591

541 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 8,599,602 0 8,599,602 0 0 0
Annual IC Time Burden (Hours) 1,614,146 0 1,614,146 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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