Information Collection Request
Model Medicare Advantage and Medicare Prescription Drug Plan Individual Enrollment Request Form (CMS-10718)
ICR 202401-0938-002 · OMB 0938-1378 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1378 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CMS-10718 Eligibility and Enrollment Eligibility and enrollment (Part D sponsor) |
Form and Instruction | Modified | Repair queued |
| Form CMS-10718 Eligibility and Enrollment Eligibility and enrollment (Beneficiaries) |
Form and Instruction | Modified | Repair queued |
| Form CMS-10718 Election Process (MA organization) |
Form and Instruction | Modified | Missing upstream |
| Form CMS-10718 Election Process (Beneficiaries) |
Form and Instruction | Modified | Repair queued |
 CMS-10718_Supporting Statement_A - CY 2025.docx |
Supporting Statement A | Uploaded 2024-01-11 | Repair queued |
| CMS Response to Public Comments - CMS-10718, OMB 0938-1378.docx |
Supplementary Document | Uploaded 2024-01-11 | Repair queued |
 CMS 10718- CY 2025 Enrollment Form Crosswalk.pdf |
Supplementary Document | Uploaded 2024-01-11 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 242684 |  Part D Communication Requirements, Review and Distribution of Marketing Materials |
Modified | ||
| 242683 | Medicare Advantage Communication Requirements Review and Distribution of Marketing Materials |
Modified | ||
| 240724 | Eligibility and Enrollment Eligibility and enrollment (Part D sponsor) |
Form and Instruction | Modified | |
| 240723 | Eligibility and Enrollment Eligibility and enrollment (Beneficiaries) |
Form and Instruction | Modified | |
| 240722 | Election Process (MA organization) |
Form and Instruction | Modified | |
| 240302 | Election Process (Beneficiaries) |
Form and Instruction | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1378 |
| Type of Information Collection | Revision of a currently approved collection |
| Previous ICR Reference No | 202306-0938-006 |
| Agency Tracking No | CM-CPC |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |