Application for Prescription Drug Plans (PDP); Application for Medicare Adantage Prescription Drug (MA-PD); Application for Cost Plans to Offer a Qualified Prescription Drug Coverage.
ICR 200501-0938-003
OMB: 0938-0936
Federal Form Document
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-0936 can be found here:
Application for Prescription
Drug Plans (PDP); Application for Medicare Adantage Prescription
Drug (MA-PD); Application for Cost Plans to Offer a Qualified
Prescription Drug Coverage.
New
collection (Request for a new OMB Control Number)
This information
collection is approved with the following condition of clearance.
HHS/CMS will solicit comments on the application during the
scheduled training sessions and will report back to OMB within one
week of the conclusion of these sessions with a plan to address
these comments through modifying the application, issuing
clarifying instructions, or other means.
Inventory as of this Action
Requested
Previously Approved
07/31/2005
07/31/2005
450
0
0
20,081
0
0
0
0
0
The Application for Prescription Drug
Plans (PDP),the Application Medicare Advantage Prescription Drug
(MA-PD), and the Application for Cost Plans to Offer a Qualified
Prescription Drug Coverage are completed by entities seeking
approval to offer Part D Benefits under the Medicare Prescription
Drug Benefit program established by section 101 of the Medicare
Prescription Drug Improvement, and Modernization Act of 2003 (MMA)
and is codified in section 1860D of the Social Security Act (the
Act).
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.