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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 202411-0938-004 · OMB 0938-0935 · Received in OIRA

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
CMS-10237_Supporting Statement_Clean.docx Supporting Statement A Uploaded 2024-11-18 Repair queued
COMPLETE_CY2026 Summary of Changes.docx Supplementary Document Uploaded 2024-11-18 Repair queued
Responses to 60-day comments_CMS-10237_102924.docx Supplementary Document Uploaded 2024-11-08 Repair queued
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 202411-0938-004
Received in OIRA 202210-0938-003
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 11/19/2024
  Requested Previously Approved
36 Months From Approved 03/31/2026
500 500
9,173 9,173
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
   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
  89 FR 64462 08/07/2024
89 FR 88782 11/08/2024
Yes
  Total Request 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 500 500 0 0 0 0
Annual Time Burden (Hours) 9,173 9,173 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$1,153,080
No
    No
    No
No
No
No
No
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.
11/19/2024