Information Collection

Enrollment Process (Beneficiaries) (§ 423.32)

IC 240723 under ICR 202512-0938-014 · OMB 0938-1378.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CMS-10718 Enrollment Process (Beneficiaries) (§ 423.32)	Form and Instruction
Form CMS-10718 Enrollment Form Enrollment Process (Beneficiaries) (§ 423.32)	Form and Instruction
CMS-10718 Enrollment Form CY 2027 - Model MA PDP Indiv Enrollment Request Form.docx	Form and Instruction
CMS-10718 Enrollment Form CY 2027 - Model MA PDP Indiv Enrollment Request Form.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 423.32

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-10718				Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Medicare Advantage Prescription Drug (MARx) System

FR Citation: 83 FR 6591

Number of Respondents: 8,700,438

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	8,700,438	582,028	8,118,410
Annual IC Time Burden (Hours)	2,610,131	174,608	2,435,523
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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