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Information Collection

Election Process (Beneficiaries) (422.60)

IC 240302 under ICR 202512-0938-014 · OMB 0938-1378.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

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Election Process (Beneficiaries) (422.60)
 
No Modified
 
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 CY 2027 - Model MA PDP Indiv Enrollment Request Form.docx Yes Yes Fillable Printable

Health Health Care Services

Medicare Advantage Prescription Drug (MARx) System  83 FR 6591

15,763,178 0
   
Individuals or Households
 
   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 15,763,178 0 0 4,065,691 0 11,697,487
Annual IC Time Burden (Hours) 4,728,953 0 0 1,219,707 0 3,509,246
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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