Medicare Prescription Drug Coverage and Your Rights

ICR 200509-0938-015

OMB: 0938-0975

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
8835 Migrated
ICR Details
0938-0975 200509-0938-015
Historical Active
HHS/CMS
Medicare Prescription Drug Coverage and Your Rights
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 11/16/2005
Retrieve Notice of Action (NOA) 09/30/2005
The agency will submit any changes to the burden estimate as it g ains program experience to enable it to more accurately estimate the hour burden associated with this collection.
  Inventory as of this Action Requested Previously Approved
11/30/2008 11/30/2008
35,000,000 0 0
583,333 0 0
0 0 0

Pursuant to 42 CFR 423.562(a)(3), a Part D plan sponsor must arrange with its network pharmacies to post or distribute notices informing enrollees to contact their plan to request a coverage determination or an exception if the enrollee disagrees with the information provided by the pharmacy.

None
None


No

1
IC Title Form No. Form Name
Medicare Prescription Drug Coverage and Your Rights CMS-10147

  Total Approved 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 35,000,000 0 0 35,000,000 0 0
Annual Time Burden (Hours) 583,333 0 0 583,333 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
09/30/2005


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