Retiree Drug Subsidy Payment Request Instructions

Retiree Drug Subsidy Payment Request Instructions

OMB: 0938-0977

IC ID: 8838

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Information Collection (IC) Details

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Retiree Drug Subsidy Payment Request Instructions
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CMS-10170 Yes Yes


    

6,000 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 6,000 0 0 0 0 6,000
Annual IC Time Burden (Hours) 222,000 0 0 0 0 222,000
Annual IC Cost Burden (Dollars) 68,136,000 0 0 68,035,000 0 101,000

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