Coordination of Benefits Between Part D Plans and Other Prescription Coverage Providers

ICR 200510-0938-004

OMB: 0938-0978

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0938-0978 200510-0938-004
Historical Active
HHS/CMS
Coordination of Benefits Between Part D Plans and Other Prescription Coverage Providers
New collection (Request for a new OMB Control Number)   No
Emergency 11/07/2005
Approved without change 11/18/2005
Retrieve Notice of Action (NOA) 10/14/2005
  Inventory as of this Action Requested Previously Approved
04/30/2006 04/30/2006
2,147,483,647 0 0
1,017,914 0 0
0 0 0

This information is necessary to assist with coordination of prescription drug benefits provided to the Medicare beneficiary at the pharmacy.

None
None


No

1
IC Title Form No. Form Name
Coordination of Benefits Between Part D Plans and Other Prescription Coverage Providers CMS-10171

  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 2,147,483,647 0 0 2,147,483,647 0 0
Annual Time Burden (Hours) 1,017,914 0 0 1,017,914 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.
10/14/2005


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