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Election Process (Beneficiaries)
Model Medicare Advantage and Medicare Prescription Drug Plan Individual Enrollment Request Form (CMS-10718)
OMB: 0938-1378
IC ID: 240302
OMB.report
HHS/CMS
OMB 0938-1378
ICR 202306-0938-006
IC 240302
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1378 can be found here:
2024-01-11 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form CMS-10718
Election Process (Beneficiaries)
Form and Instruction
Form CMS-10718
Election Process (Beneficiaries)
Form and Instruction
CMS-10718 Enrollment Form
CY 2023 Model PDP Indiv Enrollment Request Form 0938-1378.docx
Form and Instruction
Information Collection (IC) Details
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