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Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201711-0938-005 · OMB 0938-0935 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form CMS-10237 Applications for Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits Form and Instruction Modified Available
5_CMS Responses to 60_30 Day Comments_CY 2019.pdf Supplementary Document Uploaded 2018-01-29 Available
1_Summary of Changes (rev OSORA PRA).pdf Supplementary Document Uploaded 2018-01-29 Available
3_CMS-10237 - Supporting Statement A - Passback_CLEAN01252018.....docx Supporting Statement A Uploaded 2018-01-29 Available
8_CMS Responses to 60-Day Comments on the Contract Year 2019 PART C - Medi....pdf Supplementary Document Uploaded 2017-11-16 Available
IC Document Collections
IC IDCollectionTypeStatusForm
8785 Applications for Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits Form and Instruction Modified
ICR Details
0938-0935 201711-0938-005
Historical Active 201610-0938-011
HHS/CMS CM-CPC
Applications for Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits (CMS-10237)
Revision of a currently approved collection   No
Regular
Approved with change 02/02/2018
Retrieve Notice of Action (NOA) 11/16/2017
  Inventory as of this Action Requested Previously Approved
02/28/2021 36 Months From Approved 02/29/2020
380 0 310
6,246 0 10,941
0 0 0
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.
US Code: 42 USC 1395mm Name of Law: null
   PL: Pub.L. 110 - 275 161 Name of Law: Provisions relating to Part C
   PL: Pub.L. 108 - 173 1857 Name of Law: Medicare Advantage
  
None
Deregulatory
Not associated with rulemaking
  82 FR 35782 08/01/2017
82 FR 53503 11/16/2017
Yes
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 380 310 0 0 70 0
Annual Time Burden (Hours) 6,246 10,941 0 0 -4,695 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
There are significant reductions in the burden estimate for the CY 2019 application. These changes relate to: • Increased workload volume; • Changes in labor rates; • Reductions in application sections and attestations; • Reductions in application uploads; and • Removal of burden tied to other OMB control numbers. These burden reductions occur for both the industry and government burden estimates. Please refer to the supporting statement for additional information. Summary: The level of burden is projected to decrease from the CY 2018 application cycle to the CY 2019 application cycle.
$889,169
No
    No
    No
No
No
No
Uncollected
Mitch Bryman 410 786-5258 [email protected]
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
11/16/2017