Information Collection

Solicitation for Applications for Medicare Prescription Drug Plan 2027 Contracts

IC 43672 under ICR 202511-0938-020 · OMB 0938-0936.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10137 Solicitation for Application for Medicare Prescription Drug Plan 2027 Contracts Solicitation for Applications for Medicare Prescription Drug Plan 2027 Contracts	Form and Instruction
Form CMS-10137 PACE Medicare Part D Application Solicitation for Applications for Medicare Prescription Drug Plan 2027 Contracts	Form and Instruction
CMS-10137 Solicitation for Application for Medicare Prescription D 2027 Part D Application .docx	Form and Instruction
CMS-10137 PACE Medicare Part D Application 2026 PACE Part D Application .docx	Form and Instruction
2026 PACE Part D Application PRA 30 Day REDLINE.pdf 2026 PACE Part D Application Redline	IC Document
2027 Part D Application PRA 60 Day REDLINE.pdf 2027 Part D Application Redline	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10137				Yes	Yes	Fillable Printable
Form and Instruction	CMS-10137				Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 785

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 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	402	-22	424
Annual IC Time Burden (Hours)	1,724	-85	1,809
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2026 PACE Part D Application Redline		11/28/2025
2027 Part D Application Redline		11/28/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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