Solicitation for Applications for Medicare Prescription Drug Plan 2022 Contracts

Solicitation for Applications for Medicare Prescription Drug Plan 2022 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⚠️ Notice: This information collection may be referencing outdated material.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 2022 Contracts Form and Instructi
CMS-10137 Solicitation for Application for Medicare Prescription D 2022 Part D Application.pdf Form and Instruction
CMS-10137 Solicitation for Application for Medicare Prescription D 2022 Part D Application.pdf Form and Instruction
CMS-10137 PACE Medicare Part D Application 2021 PACE Part D Application.pdf Form and Instruction
CMS-10137 PACE Medicare Part D Application 2021 PACE Part D Application.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Solicitation for Applications for Medicare Prescription Drug Plan 2022 Contracts	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

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

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 2022 Contracts	2022 Part D Application.pdf		Yes	Yes	Fillable Printable
Form and Instruction	CMS-10137	PACE Medicare Part D Application	2021 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: 658	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	331	41	290
Annual IC Time Burden (Hours)	1,550	165	1,385
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.