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Federal forms, ICRs, and supporting documents

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Applications for Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits

IC 8785 under ICR 202411-0938-004 · OMB 0938-0935.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

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Applications for Part C Medicare Advantage, 1876 Cost Plans, and Employer Group Waiver Plans to Provide Part C Benefits
 
No Modified
 
Mandatory
 
42 CFR 422.505 42 CFR 422.502 42 CFR 422.514 42 CFR 422.520 42 CFR 417.400 42 CFR 422.521 42 CFR 422.500 42 CFR 422.527 42 CFR 422.503 42 CFR 422.506 42 CFR 422.524 42 CFR 422.516 42 CFR 422.508 42 CFR 422.510 42 CFR 422.512 42 CFR 422.504 42 CFR 422.501

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10237 CY 2026 Part C -Medicare Advantage and 1876 Cost Plan Expansion Application Clean_CY 2026 Medicare Advantage (Part C) Application.docx Yes Yes Fillable Printable

Health Health Care Services

 

500 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 500 0 0 0 0 500
Annual IC Time Burden (Hours) 9,173 0 0 0 0 9,173
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
CY 2026 Medicare Advantage (Part C) Application_Redline Updated REDLINE_CY 2026 Medicare Advantage (Part C) Application.docx 11/08/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.