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Solicitation for Applications for Medicare Prescription Drug Plan 2018 Contracts
Solicitation for Applications for Medicare Prescription Drug Plan 2018 Contracts (CMS-10137)
OMB: 0938-0936
IC ID: 43672
OMB.report
HHS/CMS
OMB 0938-0936
ICR 201610-0938-010
IC 43672
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-0936 can be found here:
2024-11-05 - Revision of a currently approved collection
2023-09-08 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form CMS-10137
Solicitation for Applications for Medicare Prescription Drug Plan 2018 Contracts
Form and Instruction
CMS-10137 Medicare Part D Application for New PACE Organizations 2
2017 PACE Part D Application PRA_v30day [rev 10-04-2016 by OSORA PRA].pdf
Form and Instruction
CMS-10137 Solicitation for Applications for Medicare Prescription
2018 Part D Application_PRA_v30day CLEAN [rev 11-04-2016 by OSORA PRA].pdf
Form and Instruction
Part_D_Summ_2018_Application_Revisions_technical__substantive_v60_day.docx
Crosswalk - Application
IC Document
2018 Part D Application_PRA_v60day REDLINE.docx
Redline/Strikeout - Application
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Solicitation for Applications for Medicare Prescription Drug Plan 2018 Contracts
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
42 CFR 423.153
42 CFR 423.514
42 CFR 423.112
42 CFR 423.440
42 CFR 423.512
42 CFR 423.120
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
CMS-10137
Medicare Part D Application for New PACE Organizations 2017 Contract Year
2017 PACE Part D Application PRA_v30day [rev 10-04-2016 by OSORA PRA].pdf
Yes
Yes
Fillable Printable
Form and Instruction
CMS-10137
Solicitation for Applications for Medicare Prescription Drug Plan 2018 Contracts
2018 Part D Application_PRA_v30day CLEAN [rev 11-04-2016 by OSORA PRA].pdf
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
160
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
100 %
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
160
0
-70
0
0
230
Annual IC Time Burden (Hours)
1,565
0
-544
0
0
2,109
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Crosswalk - Application
Part_D_Summ_2018_Application_Revisions_technical__substantive_v60_day.docx
11/04/2016
Redline/Strikeout - Application
2018 Part D Application_PRA_v60day REDLINE.docx
11/04/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.