Medicare Advantage & Part D Disenrollment Requests Through 1-800-MEDICARE

ICR 200811-0938-001

OMB: 0938-0741

Federal Form Document

Forms and Documents
Document
Name
Status
Supplementary Document
2008-10-30
Supplementary Document
2008-10-30
Supporting Statement A
2008-10-30
ICR Details
0938-0741 200811-0938-001
Historical Active 200510-0938-014
HHS/CMS
Medicare Advantage & Part D Disenrollment Requests Through 1-800-MEDICARE
Revision of a currently approved collection   No
Regular
Approved with change 01/08/2009
Retrieve Notice of Action (NOA) 11/04/2008
CMS acknowledges that the burden changes due to statute in this ICR constitute a PRA violation because this ICR was not submitted before the statutory provision went into effect. CMS agrees to report these burdens as a violation in the next ICB. CMS is reminded that burden changes, even when they are due to statute and not due to agency discretion, should be submitted as ICR revision requests and approved before the statutory provisions go into effect.
  Inventory as of this Action Requested Previously Approved
01/31/2012 36 Months From Approved 01/31/2009
117,000 0 50,000
19,539 0 3,300
0 0 0

Section 4001 of the Balanced Budget Act of 1997 amended the Social Security Act to add Section 1851, including 1851(c)(1), which required the establishment of a procedure to make and change Medicare Advantage elections, including disenrollment requests. The Medicare Prescription Drug Improvement and Modernization Act of 2003 amended the Social Security Act to add Section 1860D, including 1860D-1(b)(1)(A) which required the establishment of a procedure to make and change Part D elections, including disenrollment requests, and to do so in a manner similar to that established for Medicare Advantage elections.

PL: Pub.L. 105 - 33 4001 Name of Law: Balanced Budget Act of 1997
   PL: Pub.L. 108 - 173 101 Name of Law: Medicare Prescription Drug Improvement and
   US Code: 42 USC 1395w Part C Name of Law: Medicare Advantage Program
   US Code: 42 USC 1395w Part D Name of Law: Voluntary Prescription Drug Program
   Statute at Large: 18 Stat. 1851 Name of Statute: null
   Statute at Large: 18 Stat. 1860 Name of Statute: null
  
PL: Pub.L. 108 - 173 101 Name of Law: Medicare Prescription Drug Improvement and Modernization Act of 2003
US Code: 42 USC 1395w Part D Name of Law: Voluntary Prescription Drug Program
Statute at Large: 18 Stat. 1860 Name of Statute: null

Not associated with rulemaking

  73 FR 47954 08/15/2008
73 FR 63479 10/24/2008
No

1
IC Title Form No. Form Name
Medicare Advantage & Part D Disenrollment Requests Through 1-800-MEDICARE (CMS-R-257)

  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 117,000 50,000 67,000 0 0 0
Annual Time Burden (Hours) 19,539 3,300 16,239 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
Since 2005, CMS has not received any requests for the CMS-R-257 form and all disenrollments have been processed over the phone. Therefore, we are also revising this information collection to retire the CMS-R-257 form. Furthermore, we are also revising this information collection to account for requests to disenroll from Prescription Drug Plans. Medicare Prescription Drug plans were established by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) and began operation on January 1, 2006.

$254,007
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Bonnie Harkless 4107865666

  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.
11/04/2008


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