Applications for Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits (CMS-10237)

OMB 0938-0935

OMB 0938-0935

In order to provide health benefits to Medicare beneficiaries under the Medicare Advantage Program and/or the 1876 Cost Plan, applicant must meet regulatory requirements to enter into a contract with CMS, or to continue to contract with CMS. The revised Part C application is created to capture the applicants’ information.

The latest form for Applications for Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits (CMS-10237) expires 2024-01-31 and can be found here.

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Revision of a currently approved collection 2024-11-19
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Revision of a currently approved collection 2022-10-13
Revision of a currently approved collection 2020-01-07
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Revision of a currently approved collection 2019-02-13
Approved with change
Revision of a currently approved collection 2017-11-16
Approved with change
Revision of a currently approved collection 2016-11-07
Approved with change
Revision of a currently approved collection 2015-09-30
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Revision of a currently approved collection 2014-10-03
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Revision of a currently approved collection 2013-10-31
Approved with change
Revision of a currently approved collection 2012-11-21
Approved with change
Revision of a currently approved collection 2011-11-07
Approved without change
Revision of a currently approved collection 2010-09-30
Approved with change
Revision of a currently approved collection 2009-10-21
Approved without change
Extension without change of a currently approved collection 2009-06-08
Approved with change
Revision of a currently approved collection 2008-09-18
Approved without change
Revision of a currently approved collection 2008-01-11
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Extension without change of a currently approved collection 2007-07-13
Approved with change
Revision of a currently approved collection 2006-12-28
Approved without change
Revision of a currently approved collection 2006-08-22
Approved without change
Revision of a currently approved collection 2005-12-30
Approved without change
Revision of a currently approved collection 2005-07-20
Approved with change
New collection (Request for a new OMB Control Number) 2005-01-19

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