Information Collection Request

The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs) (CMS-R-262) - IRA

ICR 202401-0938-014 · OMB 0938-0763 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-0763 can be found here:

Forms and Documents

Document Name	Status
Form CMS-R-262 CY2023 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262) Form and Instruction	Modified
Appendix_A_CMS-R-262_CY2025_PBP_Sprtng_Stmnt_.docx Supporting Statement A	2024-01-25
Appendix_B_CY_2025 PBP List of Changes - 30 Days PRA.pdf Supplementary Document	2024-01-25
CY2025 PRA 60-day comments 01082024_final.docx Supplementary Document	2024-01-25

IC Document Collections

IC ID	Document Title	Status
43667	CY2023 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262) Form and Instruction	Modified

ICR Details

Status	Received in OIRA
Agency/Subagency	HHS/CMS
OMB Control No	0938-0763
Type of Information Collection	Revision of a currently approved collection
Previous ICR Reference No	202302-0938-003
Agency Tracking No	CM-CPC
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31