Model Medicare Advantage and Medicare Prescription Drug Plan Individual Enrollment Request Form (CMS-10718)

Forms and Documents

Document Name	Status
Form CMS-10718 Enrollment Procces (Part D sponsors) (423.32) Form and Instruction	Modified
Form CMS-10718 Enrollment Process (Beneficiaries) (§ 423.32) Form and Instruction	Modified
Form CMS-10718 Election Process (MA organization) (422.60) Form and Instruction	Modified
Form CMS-10718 Election Process (Beneficiaries) (422.60) Form and Instruction	Modified
CY 2027 CMS-10718_Supporting Statement_A_.docx Supporting Statement A	2025-12-16
CY 2027 CMS-10718 - Response to Public Comments.docx Supplementary Document	2025-12-11

IC Document Collections

IC ID	Document Title	Status
270344	Required Notice for Reinstatements Based on Beneficiary Cancellation of New Enrollment ((§§ 422.60 and 423.32))	Modified
242684	Part D Communication Requirments Required Materials and Content (423.2267)	Modified
242683	Medicare Advantage Communication Requirments (423.2267)	Modified
240724	Enrollment Procces (Part D sponsors) (423.32) Form and Instruction	Modified
240723	Enrollment Process (Beneficiaries) (§ 423.32) Form and Instruction	Modified
240722	Election Process (MA organization) (422.60) Form and Instruction	Modified
240302	Election Process (Beneficiaries) (422.60) Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1378	ICR Reference No: 202512-0938-014
Status: Received in OIRA	Previous ICR Reference No: 202505-0938-017
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-CPC
Title: Model Medicare Advantage and Medicare Prescription Drug Plan Individual Enrollment Request Form (CMS-10718)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 12/16/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2026
Responses	49,153,959	39,858,503
Time Burden (Hours)	12,240,174	9,916,605
Cost Burden (Dollars)	0	0

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Abstract: As established by Section 1851 of the Act, and implementing regulations at §§ 422.50 and 422.60, an MA-eligible individual who meets the eligibility requirements for enrollment into an MA plan may enroll during the enrollment periods specified in §422.62, by completing an enrollment form with the MA organization or enrolling through other mechanisms that the Centers for Medicare & Medicaid Services (CMS) determines are appropriate. In addition, the authority for requiring this data collection for PDP enrollment is section 1860D-1 of the Act, and implementing regulations at §§ 423.30 and 423.32, a Part D-eligible individual who wishes to enroll in a Medicare Prescription Drug Plan (PDP) may enroll during the enrollment periods specified in §423.38, by completing an enrollment form with the PDP, or enrolling through other mechanisms CMS determines are appropriate.

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Authorizing Statute(s): PL: Pub.L. 108 - 173 101 Name of Law: Medicare Prescription Drug, Improvement, and Modernization Act of 2003
   US Code: 42 USC 1395w–21 Name of Law: Part C- Medicare + Choice Program: Eligibility, Election and Enrollment
   PL: Pub.L. 105 - 33 4001 Name of Law: Balanced Budget Act of 1997
   US Code: 42 USC 1395w-101 Name of Law: Part D Eligible Individuals and Prescription Drug Benefit
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 45939	09/24/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 58248	12/16/2025
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 7

IC Title	Form No.	Form Name
Election Process (Beneficiaries) (422.60)	CMS-10718	Enrollment Form
Election Process (MA organization) (422.60)	CMS-10718	Enrollment Form
Enrollment Procces (Part D sponsors) (423.32)	CMS-10718	Enrollment Form
Enrollment Process (Beneficiaries) (§ 423.32)	CMS-10718	Enrollment Form
Medicare Advantage Communication Requirments (423.2267)
Part D Communication Requirments Required Materials and Content (423.2267)
Required Notice for Reinstatements Based on Beneficiary Cancellation of New Enrollment ((§§ 422.60 and 423.32))

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ICR Summary of Burden

	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	49,153,959	39,858,503	0	582,028	8,713,428	0
Annual Time Burden (Hours)	12,240,174	9,916,605	0	174,608	2,148,961	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Burden has increased due to updating this collection of information request to account for changes to administrative and cost estimates resulting from updated enrollment data and wage estimates.

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Annual Cost to Federal Government: $462

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 12/16/2025

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