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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 201901-0938-007 · OMB 0938-0935 · 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 Repair queued
CY 2020 Consolidated Public comments for 60 day Part C A.._KO comment 112918.xlsx Supplementary Document Uploaded 2019-02-12 Available
1_Summary of Changes.pdf Supplementary Document Uploaded 2019-02-12 Available
CMS 10237 Supporting Statement Part A update 30 Day.pdf Supporting Statement A Uploaded 2019-02-12 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 201901-0938-007
Active 201711-0938-005
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 without change 03/06/2019
Retrieve Notice of Action (NOA) 02/13/2019
OMB is approving this information collection request for a period of three years during which time CMS will request approval to extend or revise the collection if the Agency seeks to continue the information collection activity beyond the period approved under this action.
  Inventory as of this Action Requested Previously Approved
03/31/2022 36 Months From Approved 02/28/2021
400 0 380
6,106 0 6,246
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. The revised Part C application is created to capture the applicants’ information.
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
Not associated with rulemaking
  83 FR 43689 08/27/2018
84 FR 734 01/31/2019
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 400 380 0 20 0 0
Annual Time Burden (Hours) 6,106 6,246 0 -140 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
CMS removed two MA application sections as well as combined several attestations in order to streamline the application. CMS also consolidated the Key Personnel and Compliance Plan section of the application with the Experience and History Section. CMS does not estimate a significant reduction based on these changes. CMS removed the Health Risk Assessment Tool (HRAT) upload associated SNP applications. CMS will no longer require organizations to submit the HRAT upload. CMS estimates a reduction of one (1) hour based on the removal of this upload. CMS removed the Regional Preferred Provider Organization (RPPO) upload associated with MAapplications.
$957,760
No
    No
    No
No
No
No
Uncollected
Stephan McKenzie 410 786-1943 [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.
02/13/2019